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[Treatment of hepatocellular carcinoma: application of vascular surgery]
S Nakamura1, S Suzuki, H Konno
1Second Department of Surgery, Hamamatsu University School of Medicine, Japan.
Insights
Vascular surgical techniques for hepatocellular carcinoma (HCC) improve survival rates. Procedures like portal tumor thrombectomy and hepatic vascular exclusion offer benefits, even in cirrhotic patients, though long-term survival remains a challenge.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Vascular Surgery
Context:
- Hepatocellular carcinoma (HCC) management increasingly involves complex surgical strategies.
- Vascular involvement in HCC necessitates advanced surgical approaches.
- Current treatment paradigms are evolving to address challenging HCC cases.
Purpose:
- To review the current status of hepatic resection for HCC, focusing on vascular aspects.
- To evaluate the efficacy and safety of combined surgical procedures for HCC.
- To discuss the historical development and application of hepatic vascular exclusion (HVE).
Summary:
- Hepatic resection combined with portal tumor thrombectomy shows potential survival benefits for HCC, with 1- and 3-year survival rates of 53% and 12% respectively.
- Resection of specific liver segments with hepatic vein reconstruction facilitates functional preservation of the residual liver in cases with tumors near major vascular confluence.
- Hepatic vascular exclusion (HVE) can be safely performed, even in cirrhotic patients, using active pump technology. Resection of tumor thrombus in the right atrium has also been reported with long-term survivors.
Impact:
- Advanced vascular surgical techniques are increasingly utilized in Japan for HCC treatment, demonstrating safety in cirrhotic patients.
- These sophisticated procedures offer improved survival outcomes and functional preservation for select HCC patients.
- Further research is needed to optimize long-term survival following these complex hepatic resections for HCC.
Abstract:
The present status of hepatic resection for hepatocellular carcinoma (HCC) is reviewed with special reference to the vascular aspects. Hepatic resection combined with portal tumor thrombectomy has been attempted in Japan. This procedure may be effective in the prevention of rupture of esophageal varices and making transcatheter arterial embolization possible. According to the report of Yamaoka and his associates, the 1- and 3-year survival rates of 29 patients treated with this combined procedure were 53% and 12%, respectively. This surgical strategy may thus yield survival benefits. In patients with a tumor near the confluence of the major hepatic vein and inferior vena cava, resection of segments 4b, 7, and 8 combined with hepatic vein reconstruction has been performed, which allows functional preservation of the residual liver. The historical development of hepatic vascular exclusion (HVE) is also reviewed. HVE can be performed safely using a centrifugal active pump, even in patients with cirrhosis. Hepatic resection combined with removal of tumor thrombus in the right atrium has been carried out using extracorporeal circulation. There are reports that at least two patients undergoing this operation survived more than 2 years after surgery. The hepatic warm ischemic time should be less than 60 min. Vascular surgery techniques are being increasingly applied in Japan for the treatment of HCC. Such surgery can be performed safely even in patients with cirrhosis. Improvement of long-term survival in patients undergoing such procedures remains an unresolved problem, however.