Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

Background Hepatocellular carcinoma (HCC) with tumour thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is a rare advanced disease state with a poor prognosis. The aim of this study was to examine survival after surgical resection. Methods Patients with HCC and TT of either the IVC...

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Main Authors: S. Matsukuma, H. Eguchi, H. Wada, T. Noda, Y. Shindo, Y. Tokumitsu, H. Matsui, H. Takahashi, S. Kobayashi, H. Nagano
Format: Article
Language:English
Published: Oxford University Press 2020-04-01
Series:BJS Open
Online Access:https://doi.org/10.1002/bjs5.50258
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spelling doaj-4af9ccf343484196b297a789d73ba1fd2021-04-02T12:18:31ZengOxford University PressBJS Open2474-98422020-04-014224125110.1002/bjs5.50258Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atriumS. Matsukuma0H. Eguchi1H. Wada2T. Noda3Y. Shindo4Y. Tokumitsu5H. Matsui6H. Takahashi7S. Kobayashi8H. Nagano9Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine Yamaguchi JapanDepartment of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka JapanDepartment of Digestive Surgery Osaka International Cancer Institute Osaka JapanDepartment of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka JapanDepartment of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine Yamaguchi JapanDepartment of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine Yamaguchi JapanDepartment of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine Yamaguchi JapanDepartment of Digestive Surgery Osaka International Cancer Institute Osaka JapanDepartment of Gastroenterological Surgery Osaka University Graduate School of Medicine Osaka JapanDepartment of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine Yamaguchi JapanBackground Hepatocellular carcinoma (HCC) with tumour thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is a rare advanced disease state with a poor prognosis. The aim of this study was to examine survival after surgical resection. Methods Patients with HCC and TT of either the IVC or RA, who underwent liver resection between February 1997 and July 2017, were included. Their short‐ and long‐term outcomes and surgical details were analysed retrospectively. Results Thirty‐seven patients were included; 16 patients had TT in the IVC below the diaphragm, eight had TT in the IVC above the diaphragm, and 13 had TT entering the RA. Twelve patients had advanced portal vein TT (portal vein invasion (Vp) greater than Vp3 and Vp4), ten had bilobar disease, and 12 had extrahepatic disease. There were no in‐hospital deaths, although two patients died within 90 days. Median survival did not differ between patients who had resection with curative intent (18·7 months) and those with residual tumour in the lung only (20·7 months), but survival was poor for patients with residual tumour in the liver (8·3 months). Conclusion Liver resection with thrombectomy for advanced HCC with TT in the IVC or RA is safe and feasible, leading to moderate survival.https://doi.org/10.1002/bjs5.50258
collection DOAJ
language English
format Article
sources DOAJ
author S. Matsukuma
H. Eguchi
H. Wada
T. Noda
Y. Shindo
Y. Tokumitsu
H. Matsui
H. Takahashi
S. Kobayashi
H. Nagano
spellingShingle S. Matsukuma
H. Eguchi
H. Wada
T. Noda
Y. Shindo
Y. Tokumitsu
H. Matsui
H. Takahashi
S. Kobayashi
H. Nagano
Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium
BJS Open
author_facet S. Matsukuma
H. Eguchi
H. Wada
T. Noda
Y. Shindo
Y. Tokumitsu
H. Matsui
H. Takahashi
S. Kobayashi
H. Nagano
author_sort S. Matsukuma
title Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium
title_short Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium
title_full Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium
title_fullStr Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium
title_full_unstemmed Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium
title_sort liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium
publisher Oxford University Press
series BJS Open
issn 2474-9842
publishDate 2020-04-01
description Background Hepatocellular carcinoma (HCC) with tumour thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is a rare advanced disease state with a poor prognosis. The aim of this study was to examine survival after surgical resection. Methods Patients with HCC and TT of either the IVC or RA, who underwent liver resection between February 1997 and July 2017, were included. Their short‐ and long‐term outcomes and surgical details were analysed retrospectively. Results Thirty‐seven patients were included; 16 patients had TT in the IVC below the diaphragm, eight had TT in the IVC above the diaphragm, and 13 had TT entering the RA. Twelve patients had advanced portal vein TT (portal vein invasion (Vp) greater than Vp3 and Vp4), ten had bilobar disease, and 12 had extrahepatic disease. There were no in‐hospital deaths, although two patients died within 90 days. Median survival did not differ between patients who had resection with curative intent (18·7 months) and those with residual tumour in the lung only (20·7 months), but survival was poor for patients with residual tumour in the liver (8·3 months). Conclusion Liver resection with thrombectomy for advanced HCC with TT in the IVC or RA is safe and feasible, leading to moderate survival.
url https://doi.org/10.1002/bjs5.50258
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