Surgical management of hepatocellular carcinoma with tumor thrombi in the inferior vena cava or right atrium

Wakayama Kenji; Kamiyama Toshiya; Yokoo Hideki; Kakisaka Tatsuhiko; Kamachi Hirofumi; Tsuruga Yosuke; Nakanishi Kazuaki; Shimamura Tsuyoshi; Todo Satoru; Taketomi Akinobu

Title	en Surgical management of hepatocellular carcinoma with tumor thrombi in the inferior vena cava or right atrium
Creator	en Wakayama, Kenji en Kamiyama, Toshiya NRID 1000080322816 en Yokoo, Hideki NRID 1000070399947 en Kakisaka, Tatsuhiko en Kamachi, Hirofumi NRID 1000060374237 en Tsuruga, Yosuke en Nakanishi, Kazuaki NRID 1000080374338 en Shimamura, Tsuyoshi NRID 1000000333617 en Todo, Satoru NRID 1000060136463 en Taketomi, Akinobu NRID 1000070363364
Accessrights	open access
Rights	http://creativecommons.org/licenses/by/3.0/ en Creative Commons Attribution 3.0 Unported
Subject	Other en Hepatocellular carcinoma Other en Inferior vena cava Other en Right atrium Other en Tumor thrombus Other en Surgery NDC 490
Description	Abstract en Background: The prognosis for advanced hepatocellular carcinoma (HCC) with tumor thrombi in the inferior vena cava (IVC) or right atrium (RA) is poor, and there is no established effective treatment for this condition. Thus study aimed to evaluate the efficacy of surgical resection and prognosis after surgery for such cases. Methods: Between January 1990 and December 2012, 891 patients underwent hepatectomy for HCC at our institution. Of these, 13 patients (1.5%) diagnosed with advanced HCC with tumor thrombi in the IVC or RA underwent hepatectomy and thrombectomy. Data detailing the surgical outcome were evaluated and recurrence-free and overall survival rates were calculated using the Kaplan-Meier method. Results: Seven patients had an IVC thrombus and six had an RA thrombus. Extra-hepatic metastasis was diagnosed in 8 of 13 patients. Surgical procedures included three extended right lobectomies, three extended left lobectomies, five right lobectomies, and two sectionectomies. Right adrenal gland metastases were excised simultaneously in two patients. All IVC thrombi were removed under hepatic vascular exclusion and all RA thrombi were removed under cardiopulmonary bypass (CPB). Four patients (30.8%) experienced controllable postoperative complications, and there was no surgical mortality. The mean postoperative hospital stay for patients with IVC and RA thrombi was 23.6 +/- 12.5 days and 21.2 +/- 4.6 days, respectively. Curative resection was performed in 5 of 13 cases. The 1- and 3-year overall survival rates were 50.4%, and 21.0%, respectively, and the median survival duration was 15.3 months. The 1- and 3-year overall survival rates for patients who underwent curative surgical resection were 80.0% and 30.0%, respectively, with a median survival duration of 30.8 months. All patients who underwent curative resection developed postoperative recurrences, with a median recurrence-free survival duration of 3.8 months. The 1- year survival rate for patients who underwent noncurative surgery and had residual tumors was 29.2%, with a median survival duration of 10.5 months. Conclusions: Aggressive surgical resection for HCC with tumor thrombi in the IVC or RA can be performed safely and may improve the prognoses of these patients. However, early recurrence and treatment for recurrent or metastatic tumors remain unresolved issues.
Publisher	en Biomed central ltd
Date	Issued2013-10-05
Language	eng
Resource Type	journal article
Version Type	VoR
Identifier	HDL http://hdl.handle.net/2115/53612
Relation	isIdenticalTo DOI https://doi.org/10.1186/1477-7819-11-259 PMID 24093164
Journal	PISSN 1477-7819 NCID AA12048269 en World journal of surgical oncology Volume Number11 Issue Number1 Page Start259
File	fulltext World J Surg Oncol_11(1)_259.pdf 1.81 MB (application/pdf) Issued2013-10-05
Oaidate	2023-07-26