Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: A propensity score analysis

Abstract

ObjectivesThe optimal surgical resection method for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) that maximizes both safety and long-term outcome has not yet been determined. The aim of this study was to compare the clinical outcomes following peeling off versus en bloc resection for PVTT.MethodsFrom 2005 to 2012, 252 patients with HCC and type I/II PVTT who underwent hepatic resection were divided into two groups according to whether they received en bloc resection (n = 113) or peeling off resection (n = 139). The clinical outcomes were compared before and after propensity score matching.ResultsThe propensity model matched 113 patients with en bloc resection for further analyses. After matching, overall survival (OS) and disease-free survival (DFS) rates were significantly increased in the en bloc group compared with the peeling off group (p = 0.011 and p = 0.015). A multivariate analysis indicated that en bloc resection independently improved both OS and DFS (HR = 1.471, 95% CI: 1.071-2.018, p = 0.017 and HR = 1.415, 95% CI: 1.068-1.874, P=0.016). The adverse events were not significantly different between the two groups. However, the peeling off group showed a significantly increased recurrence rate of vascular invasion compared with the en bloc group (23.9% vs. 9.7%, p = 0.005). Similar results were also demonstrated prior to the matched analysis.ConclusionsAn en bloc resection is safe and confers a survival advantage compared with a peeling off resection in HCC patients with PVTT; thus, en bloc resection should be recommended as a standard treatment for these patients when possible.

Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi‐institutional analysis

“…A systematic review of hilar cholangiocarcinoma data similarly noted that perioperative outcomes among patients undergoing curative resection with or without portal vein reconstruction were markedly different . However, while Chok et al noted a modest increase in morbidity among HCC patients who underwent en bloc resection and reconstruction of the PV, a similar study examining patients with hepatocellular carcinoma noted no difference in adverse perioperative events among patients who underwent hepatectomy with or without concomitant en bloc PV resection . In the current study, perioperative complications were common as nearly one‐half of patients experienced at least one complication.…”

“…A systematic review of hilar cholangiocarcinoma data similarly noted that perioperative outcomes among patients undergoing curative resection with or without portal vein reconstruction were markedly different. 27 However, while Chok 29 In the current study, perioperative complications were common as nearly one-half of patients experienced at least one complication. The odds of a perioperative complication were comparable, however, among patients who did and did not undergo a major vascular resection (OR 0.68, 95%CI, 0.33-1.45, P = 0.32).…”

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.…”

Comparison of hepatic resection and transarterial chemoembolization for UICC stage T3 hepatocellular carcinoma: a propensity score matching study

“…As in China, more than 50% new developed cases occurred in this country alone, which usually arises as a result of a chronic liver disease, especially hepatitis B virus (HBV) related. Due to its greatly invasive malignant features, HCC has a characteristic propensity to invade into portal vein, or to develop intra-hepatic metastasis, which was regarded as one of the most adverse prognostic factors [ 3 ]. Although several staging systems have been proposed for determining the stage and prognosis of HCC, no consensus exists on the best classification system [ 2 , 4 ].…”

“…According to Barcelona clinic liver cancer (BCLC) staging system, most UICC stage T3 HCC cases are classified as being Stages B or C, therefore transarterial chemoembolization (TACE) or Sorafenib, rather than hepatic resection (HR) are recommended as the optimal therapy for patients in these stages in Europe or North America [ 5 ]. However, therapy strategy may be a little different in Asian-Pacific areas [ 2 , 3 , 6 , 7 ]. Until now, it seems difficult to reach a common consensus on the indication of HR for HCC patients worldwide.…”