Hepatic Resection in Patients with Hepatocellular Carcinoma Accompanied by Portal Vein Thrombus

Purpose: Although surgical resection is the most effective treatment for hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT), the recurrence rate is very high and prognosis is poor. This retrospective analysis aimed to establish a surgical strategy for patients with portal vein thrombus and to identify predictors of tumor thrombus in these patients. Methods: From 2006 to 2007, 63 hepatocellular carcinoma patients with portal vein thrombus detected by preoperative imaging underwent hepatic resection, and their clinical data were retrospectively analyzed. Possible prognostic factors for survival were analyzed with postoperative survival curves, and significant factors were determined by univariate and multivariate analysis. Results: 31 patients (49.2%) with portal vein tumor thrombus were detected by pathologic reports in 63 HCC patients with portal vein thrombus. Significant prognostic factors included Serum Albumin ${\leq}$3.5 g/dl, Alkaline phosphatase (ALP)${\geq}$100 IU/L, Tumor size${\geq}$10 cm, non-expanding type, PVTT and Alpha-feto protein (AFP)${\geq}$104 IU/L by univariate analysis. Independent prognostic factors included PVTT. Conclusion: PVTT is not always detected in patients with HCC accompanied by portal vein thrombus. Although patients have a portal vein tumor thrombus, some patients have greater long-term survival. Hepatic resection should be considered for patients with portal vein thrombus.

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