Hepatic resection or transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus

Abstract

The role of hepatic resection in hepatocellular carcinoma (HCC) with accompanying portal vein tumor thrombus (PVTT) remains controversial. This study aimed to evaluate the surgical outcomes of hepatic resection compared with those of transarterial chemoembolization (TACE) in HCC patients. A retrospective study was conducted using the medical records of 230 HCC patients with portal vein invasion who underwent hepatic resection (96 patients) or TACE (134 patients). The baseline characteristics, tumor characteristics, clinicopathological parameters, and overall survival rates were compared between the 2 groups. The baseline and tumor characteristics were comparable between the hepatic resection and TACE groups. The overall complication rate was 35.4% in the hepatic resection group, which was significantly lower than that in the TACE group (73.0%, P <0.001). However, the serious complication rate (grade ≥3) in the hepatic resection group was 13.5%, which was significantly higher than that in the TACE group (P = 0.003). The cumulative overall survival rates at 1, 3, and 5 years in the hepatic resection group were 86.5%, 60.4%, and 33.3%, respectively. These rates were much higher than those in the TACE group (1-year: 77.6%; 3-year: 47.8%; and 5-year: 20.9%; P = 0.021). The long-term survival was notably better in the patients with types I and II PVTT than in the patients with types III and IV PVTT (P <0.05). The univariate and multivariate analyses indicated that types III and IV PVTT and TACE may have contributed to the poor overall survival following surgery. In HCC patients with PVTT and compensated liver function, hepatic resection is a safe and effective surgical protocol, particularly for patients with type I or II PVTT.

Hepatic resection compared to chemoembolization in intermediate‐ to advanced‐stage hepatocellular carcinoma: A meta‐analysis of high‐quality studies

“…The details and reasons for exclusion requiring consensus between the authors are described in http://onlinelibrary.wiley.com/doi/10.1002/hep.29883/suppinfo. Finally, 18 studies reporting PH versus TACE in BCLC stage B or stage C patients were included in the systematic review and meta‐analysis.…”

“…Eighteen trials (one RCT, five PSM NRCTs, and 12 NRCTs) consisting of 20 data sets and a total of 5,986 patients were included in the meta‐analysis. The RCT was a single‐center trial conducted in China .…”

“…Although the role of surgery in this patient group was insufficiently defined, an increasing number of studies have attempted aggressive surgical resection to remove all tumor tissue detected during imaging studies in patients with well‐preserved liver function. Previous reports have suggested that PH is a safe and effective treatment if tumor thrombus is confined to the first (PVT type I) or the second (PVT type II) branch of the main portal vein (3‐ and 5‐year survival rates ranging from 17% to 54% and from 10% to 38%, respectively) . Conversely, when the tumor thrombus extends into the main portal vein trunk (PVT type III‐IV), the 3‐ and 5‐year survival rates decreased (range, 4%‐14% and 0%‐5%, respectively) .…”

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

“…Surgery has been considered contraindicated by many institutions, including the BCLC system [41] . However, many studies, particularly those from the Asian centers, have reported hepatic resection to be safe and effective for patients with portal vein invasion [28,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] [ Table 3]. The median 1-, 3-and 5-year overall survival rates for patients with all forms of portal vein invasion treated with surgery were 61.0%, 32.9% and 27.0% respectively.…”

“…[48] Vp1 to Vp3 181 60 42 33 32 2002-2012 2016 China Zheng et al . [49] All Choi et al . [76] Vp1 Table 10].…”