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Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus: a novel classification.

Xu JF, Liu XY, Wang S, Wen HX - World J Surg Oncol (2015)

Bottom Line: Our study introduced a novel classification of HCC with PVTT and compared the outcomes of surgical treatment between different groups.For further study, group B had significantly better overall survival than group A (P = 0.033).Group A had significantly higher incidence of recurrence than group B (P = 0.021).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, The Fourth Affiliated Hospital of Zhejiang, University School of Medicine, East building in Huajiachi campus, Kaixuan road 268, Hangzhou, Zhejiang, 310020, China. zjxujiangfeng@hotmail.com.

ABSTRACT

Background: The hepatic resection for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) which is not uncommon at clinic continues to be debated. Our study introduced a novel classification of HCC with PVTT and compared the outcomes of surgical treatment between different groups.

Methods: From January 2008 to December 2012, a total of 56 cases of HCC with PVTT underwent liver resection combined with thrombectomy. Clinical pathological features and surgical data of these patients were retrospectively studied. The patients were divided into two groups. Cumulative overall and disease-free survival curves of the patients were compared according to different groups.

Results: Sixteen patients (28.6%) belonging to group A were compared to 40 patients (71.4%) belonging to group B. The rates of capsular formation and tumor number showed differences between the two groups (P = 0.047, P = 0.032). Group A had more liver cirrhosis than group B (P = 0.047). The patients with large blood loss (≥1,000) were more in group A, as well. There was no significant difference in complications between the two groups except the ascites (P = 0.028). The 1-year overall survival rate of group A after liver resection was 31.5%. The 1-, 3-, and 5-year overall survival rates of group B were 62.3%, 16.1%, and 5.2%, respectively. For further study, group B had significantly better overall survival than group A (P = 0.033). Group A had significantly higher incidence of recurrence than group B (P = 0.021).

Conclusions: Liver resection combined with thrombectomy for HCC with PVTT can get better outcome in the HCC patients with PVTT involving only one branch (left/right) of portal vein (group B) compared to patients with PVTT involving the main portal vein trunk or both the left and right portal veins (group A).

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Different classifications of PVTT. (A), (B), and (C) belong to group A; (D) and (E) belong to group B. (A) Tumor thrombi involving the main portal vein trunk, the left portal vein and the right portal vein; (B) tumor thrombi involving the main portal vein trunk; (C) tumor thrombi involving both the left and right portal veins; (D) tumor thrombi involving only the right branch of portal vein; and (E) tumor thrombi involving only the left branch of portal vein. PV, portal vein; PVTT, portal vein tumor thrombus.
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Fig1: Different classifications of PVTT. (A), (B), and (C) belong to group A; (D) and (E) belong to group B. (A) Tumor thrombi involving the main portal vein trunk, the left portal vein and the right portal vein; (B) tumor thrombi involving the main portal vein trunk; (C) tumor thrombi involving both the left and right portal veins; (D) tumor thrombi involving only the right branch of portal vein; and (E) tumor thrombi involving only the left branch of portal vein. PV, portal vein; PVTT, portal vein tumor thrombus.

Mentions: Sixteen patients (28.6%) belonging to group A were compared to 40 patients (71.4%) belonging to group B. The new classification for HCC with PVTT was shown in Figure 1. The clinical and pathologic parameters of the two groups were shown in Table 1. There were 10 patients (62.5%) that had positive hepatitis B in group A compared to 26 patients (65%) in group B. Thirteen patients (81.2%) had liver cirrhosis in group A while in group B, only 21 patients (52.5%) had liver cirrhosis. Group A had significantly more liver cirrhosis patients than in group B (P = 0.047). The rates of capsular formation and tumor number showed differences between two groups (P = 0.047, P = 0.032). The capsular formation in group A was 18.8% compared to 47.5% in group B. The tumor size in group A was 6.5 ± 5.0 while in group B, it was 5.3 ± 4.3.Figure 1


Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus: a novel classification.

Xu JF, Liu XY, Wang S, Wen HX - World J Surg Oncol (2015)

Different classifications of PVTT. (A), (B), and (C) belong to group A; (D) and (E) belong to group B. (A) Tumor thrombi involving the main portal vein trunk, the left portal vein and the right portal vein; (B) tumor thrombi involving the main portal vein trunk; (C) tumor thrombi involving both the left and right portal veins; (D) tumor thrombi involving only the right branch of portal vein; and (E) tumor thrombi involving only the left branch of portal vein. PV, portal vein; PVTT, portal vein tumor thrombus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352541&req=5

Fig1: Different classifications of PVTT. (A), (B), and (C) belong to group A; (D) and (E) belong to group B. (A) Tumor thrombi involving the main portal vein trunk, the left portal vein and the right portal vein; (B) tumor thrombi involving the main portal vein trunk; (C) tumor thrombi involving both the left and right portal veins; (D) tumor thrombi involving only the right branch of portal vein; and (E) tumor thrombi involving only the left branch of portal vein. PV, portal vein; PVTT, portal vein tumor thrombus.
Mentions: Sixteen patients (28.6%) belonging to group A were compared to 40 patients (71.4%) belonging to group B. The new classification for HCC with PVTT was shown in Figure 1. The clinical and pathologic parameters of the two groups were shown in Table 1. There were 10 patients (62.5%) that had positive hepatitis B in group A compared to 26 patients (65%) in group B. Thirteen patients (81.2%) had liver cirrhosis in group A while in group B, only 21 patients (52.5%) had liver cirrhosis. Group A had significantly more liver cirrhosis patients than in group B (P = 0.047). The rates of capsular formation and tumor number showed differences between two groups (P = 0.047, P = 0.032). The capsular formation in group A was 18.8% compared to 47.5% in group B. The tumor size in group A was 6.5 ± 5.0 while in group B, it was 5.3 ± 4.3.Figure 1

Bottom Line: Our study introduced a novel classification of HCC with PVTT and compared the outcomes of surgical treatment between different groups.For further study, group B had significantly better overall survival than group A (P = 0.033).Group A had significantly higher incidence of recurrence than group B (P = 0.021).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, The Fourth Affiliated Hospital of Zhejiang, University School of Medicine, East building in Huajiachi campus, Kaixuan road 268, Hangzhou, Zhejiang, 310020, China. zjxujiangfeng@hotmail.com.

ABSTRACT

Background: The hepatic resection for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) which is not uncommon at clinic continues to be debated. Our study introduced a novel classification of HCC with PVTT and compared the outcomes of surgical treatment between different groups.

Methods: From January 2008 to December 2012, a total of 56 cases of HCC with PVTT underwent liver resection combined with thrombectomy. Clinical pathological features and surgical data of these patients were retrospectively studied. The patients were divided into two groups. Cumulative overall and disease-free survival curves of the patients were compared according to different groups.

Results: Sixteen patients (28.6%) belonging to group A were compared to 40 patients (71.4%) belonging to group B. The rates of capsular formation and tumor number showed differences between the two groups (P = 0.047, P = 0.032). Group A had more liver cirrhosis than group B (P = 0.047). The patients with large blood loss (≥1,000) were more in group A, as well. There was no significant difference in complications between the two groups except the ascites (P = 0.028). The 1-year overall survival rate of group A after liver resection was 31.5%. The 1-, 3-, and 5-year overall survival rates of group B were 62.3%, 16.1%, and 5.2%, respectively. For further study, group B had significantly better overall survival than group A (P = 0.033). Group A had significantly higher incidence of recurrence than group B (P = 0.021).

Conclusions: Liver resection combined with thrombectomy for HCC with PVTT can get better outcome in the HCC patients with PVTT involving only one branch (left/right) of portal vein (group B) compared to patients with PVTT involving the main portal vein trunk or both the left and right portal veins (group A).

Show MeSH
Related in: MedlinePlus