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Hepatic resection for hepatocellular carcinoma with a tumor thrombus extending to inferior vena cava
Insights
Hepatic resection for liver cancer with inferior vena cava (IVC) tumor thrombus is safe and effective. Prognosis is better when the thrombus is confined to the hepatic vein, not the portal vein.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) with inferior vena cava (IVC) tumor thrombus presents a surgical challenge.
- Evaluating the efficacy and safety of hepatic resection in such cases is crucial.
Observation:
- Four patients with HCC and IVC tumor thrombus underwent hepatic resection under hepatic vascular exclusion (HVE).
- All patients had successful hepatic resections and thrombectomies without major complications.
Findings:
- One patient with additional portal vein thrombus experienced recurrence and died within 6 months.
- Three patients without portal vein involvement survived longer post-operatively.
Implications:
- Hepatic resection is an acceptable and safe treatment for HCC with IVC tumor thrombus.
- Confining tumor thrombus to the hepatic vein, excluding portal vein involvement, correlates with improved patient prognosis.
Abstract:
The significance of hepatic resection for hepatocellular carcinoma with a tumor thrombus in the inferior vena cava (IVC) is clarified. We operated on 4 patients with HCC who had a tumor thrombus extending to the IVC through the hepatic vein under hepatic vascular exclusion (HVE). In all patients the hepatic resections and thrombectomies were successful without major complication. One patient accompanied with a tumor thrombus in the portal vein had a rash recurrence in the remnant liver and died 6 months after operation. However, three patients without tumor thrombus in the portal vein survived relatively longer post-operatively. Hepatic resection for HCC with tumor thrombus in IVC is acceptable treatment as it is safe. It is considered that better prognoses can be maintained when a tumor thrombus is located only in the hepatic vein, and not in the portal vein.