Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus: a novel classification

Abstract

Background: The hepatic resection for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) which is not uncommon at clinic continues to be debated. Our study introduced a novel classification of HCC with PVTT and compared the outcomes of surgical treatment between different groups.

Methods: From January 2008 to December 2012, a total of 56 cases of HCC with PVTT underwent liver resection combined with thrombectomy. Clinical pathological features and surgical data of these patients were retrospectively studied. The patients were divided into two groups. Cumulative overall and disease-free survival curves of the patients were compared according to different groups.

Results: Sixteen patients (28.6%) belonging to group A were compared to 40 patients (71.4%) belonging to group B. The rates of capsular formation and tumor number showed differences between the two groups (P = 0.047, P = 0.032). Group A had more liver cirrhosis than group B (P = 0.047). The patients with large blood loss (≥1,000) were more in group A, as well. There was no significant difference in complications between the two groups except the ascites (P = 0.028). The 1-year overall survival rate of group A after liver resection was 31.5%. The 1-, 3-, and 5-year overall survival rates of group B were 62.3%, 16.1%, and 5.2%, respectively. For further study, group B had significantly better overall survival than group A (P = 0.033). Group A had significantly higher incidence of recurrence than group B (P = 0.021).

Conclusions: Liver resection combined with thrombectomy for HCC with PVTT can get better outcome in the HCC patients with PVTT involving only one branch (left/right) of portal vein (group B) compared to patients with PVTT involving the main portal vein trunk or both the left and right portal veins (group A).

Figure 1

Different classifications of PVTT. (A), (B), and (C) belong to group A; (D) and (E) belong to group B. (A) Tumor thrombi involving the main portal vein trunk, the left portal vein and the right portal vein; (B) tumor thrombi involving the main portal vein trunk; (C) tumor thrombi involving both the left and right portal veins; (D) tumor thrombi involving only the right branch of portal vein; and (E) tumor thrombi involving only the left branch of portal vein. PV, portal vein; PVTT, portal vein tumor thrombus.

Figure 2

Overall survival and disease-free survival curves of group A and group B. Group B had significantly better overall and disease-free survival curves than group A (P = 0.033; P = 0.021).

Figure 3

Overall survival curves of the subgroups according to Figure 1 . There was no significant difference between group A, group B, and group C (P = 0.675). There was no significant difference between group D and group E (P = 0.383).