Strategy of treatment for hepatocellular carcinomas with vascular infiltration in patients undergoing hepatectomy
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Published on: May 24, 2024
Atsushi Nanashima1, Syuuichi Tobinaga, Masaki Kunizaki
1Division of Surgical Oncology, Hepatology, Nagasaki University Hospital, Nagasaki, Japan. a-nanasm@alpha.med.nagasaki-u.ac.jp
Background And Objectives:
Vascular infiltration (VI) is an important prognostic factor for hepatocellular carcinoma (HCC) and predictive parameters are necessary to preoperatively decide treatment strategies in patients with HCC.
Methods:
Relationships between presence and degree of VI in the portal and hepatic veins and bile duct, and post-hepatectomy survival were examined in 271 HCC patients who underwent hepatectomy.
Results:
VI was observed in 81 patients (30%). Disease-free and overall survival rates was significantly lower in patients with VI than in patients without VI, and became poorer according to the degree of infiltration (P < 0.01). Multiple, increased size, non-meeting of Milan criteria, irregular macroscopic findings and increased PIVKA-II levels were associated with degree of VI in portal vein (P < 0.01). Increased size and increased PIVKA-II level were associated with degree of VI in hepatic vein (P < 0.05). Non-meeting of Milan criteria was associated with degree of infiltration in bile duct (P = 0.034). Survival was significantly better following anatomical resection than with non-anatomical resection and, furthermore, survival was better with surgical margins >5 mm than with shorter margins in patients who underwent non-anatomical resection.
Conclusion:
Adequate extent of operative procedures, but not limited resection with short margins, is useful when predictive parameters associated with VI are observed.