Abstract
Background. Prognosis of hepatocellular carcinoma (HCC) with tumor thrombus in the main portal
vein (MPV), inferior vena cava (IVC), or extrahepatic bile duct (EBD) treated by conventional
therapies has been considered poor. This study aimed to evaluate the efficacy of hepatic
arterial infusion chemotherapy after surgical resection as an adjuvant therapy or
as a treatment for intrahepatic recurrence of HCC with tumor thrombus in MPV, IVC,
or EBD. Methods. Nineteen patients with HCC and tumor thrombus in the MPV, IVC, or EBD who underwent
hepatectomy with thrombectomy were reviewed retrospectively. Results. The overall 3-year survival rate was 48.5%. Two patients with postoperative residual
tumor thrombus died within 6 months owing to rapid progression of the residual tumor
thrombus. Five patients survived more than 5 years after their operations. Tumors
disappeared completely in 3 patients after hepatic arterial infusion chemotherapy
with a combination of cisplatinum and 5-fluorouracil, and the longest survival period
was 17 years and 11 months in a patient with EBD thrombus. Conclusions. If hepatic reserve is satisfactory, an aggressive surgical approach combined with
chemotherapy seems to be of benefit for patients having HCC with tumor thrombus in
the MPV, IVC, or EBD. (Surgery 2002;131:300-10.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi.Hepatogastroenterology. 1994; 41: 349-354
- Management of hepatocellular carcinoma presenting as obstructive jaundice.Am J Surg. 1990; 160: 280-282
- Obstructive jaundice secondary to ruptured hepatocellular carcinoma into the common bile duct. Surgical experiences of 20 cases.Cancer. 1994; 73: 1335-1340
- The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study.Cancer. 1997; 79: 2087-2093
- Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival.Cancer. 1996; 77: 2217-2222
- Improved survival for hepatocellular cancer with combination surgery and multimodality treatment.Ann Surg. 1993; 217: 149-154
- Hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumor thrombi.Surgery. 1990; 108: 821-827
- Chemoembolization.in: Diagnosis and treatment of hepatocellular carcinoma. : Greenwich Medical Media, London1997: 307-326
- Primary treatment of hepatocellular carcinoma by arterial chemoembolization.Am J Surg. 1992; 163: 387-394
- Hepatic artery embolization in 120 patients with unresectable hepatoma.Radiology. 1983; 148: 397-401
- Radiotherapy for hepatocellular carcinoma: clinicopathological study of seven autopsy cases.Hepatogastroenterology. 1994; 41: 427-431
- Treatment of small hepatocellular carcinomas.Lancet. 1992; 340: 285-288
- Role of radiotherapy in the treatment of hepatocellular carcinoma.Rays. 1990; 15: 423-431
- Hepatocellular carcinoma: update on diagnosis and treatment.Dig Dis. 1995; 13: 81-91
- An improved technic for vascular isolation of the liver: experimental study and case reports.Ann Surg. 1996; 163: 237-241
- Hepatic resection for hepatocellular carcinoma with a tumor thrombus extending to inferior vena cava.Hepatogastroenterology. 1997; 44: 798-802
- Hepatic vascular exclusion (HVE) for major liver resections.Int Surg. 1987; 72: 78-81
- Major hepatic resection under total vascular exclusion.Ann Surg. 1989; 210: 13-19
- Major hepatic resection using vascular isolation and hypothermic perfusion.Ann Surg. 1974; 180: 644-652
- Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass.Arch Surg. 1992; 127: 276-280
- Hepatectomy under extracorporeal circulation.Surgery. 1995; 118: 98-102
- A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use.Ann Surg. 1994; 219: 342-346
- The efficacy of continuous local arterial infusion of 5-fluorouracil and cisplatin through an implanted reservoir for severe advanced hepatocellular carcinoma.Oncology. 1995; 52: 295-299
- Hepatic arterial infusion chemotherapy with continuous low dose administration of cisplatin and 5-fluorouracil for multiple recurrence of hepatocellular carcinoma after surgical treatment.Oncol Rep. 1999; 6: 587-591
- Investigation of microwave coagulo-necrotic therapy for 21 patients with small hepatocellular carcinoma less than 5 cm in diameter.J Jpn Surg Soc. 1993; 94: 359-365
- Extension of surgical indication for advanced hepatocellular carcinoma: is it possible to prolong life span or improve quality of life?.Hepatogastroenterology. 1996; 43: 1172-1181
- Successful surgical treatment of hepatocellular carcinoma invading into biliary tree.HPB Surg. 1991; 4: 237-244
- Hepatocellular carcinoma with tumor thrombus extending into the right atrium: report of a successful resection with the use of cardiopulmonary bypass.Surgery. 1991; 109: 214-219
- Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein.World J Surg. 1992; 16: 1172-1176
- Implications of surgical treatment for advanced hepatocellular carcinoma with tumor thrombi in the portal vein.Hepatogastroenterology. 1996; 43: 637-643
- Hepatic resection with tumor thrombectomy for hepatocellular carcinoma with tumor thrombi in the major vasculatures.Hepatogastroenterology. 1999; 46: 1862-1869
- Obstructive jaundice due to hepatocarcinoma with intraductal growth. Report of a successful resection.HPB Surg. 1990; 2: 73-76
- Hepatic resection for hepatocellular carcinoma.Surgery. 1990; 107: 511-520
Article info
Publication history
Accepted:
September 22,
2001
Footnotes
*Reprint requests: Shuichi Fukuda, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, Japan 830-0011.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.