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World J Hepatol. Dec 28, 2017; 9(36): 1296-1304
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1296
Hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus
Toshiya Kamiyama, Tatsuhiko Kakisaka, Tatsuya Orimo, Kenji Wakayama
Toshiya Kamiyama, Tatsuhiko Kakisaka, Tatsuya Orimo, Kenji Wakayama, Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toshiya Kamiyama, MD, PhD, Assistant Professor, Surgeon, Surgical Oncologist, Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan. t-kamiya@med.hokudai.ac.jp
Telephone: +81-11-7065927 Fax: +81-11-7177515
Received: September 29, 2017
Peer-review started: October 2, 2017
First decision: November 3, 2017
Revised: November 10, 2017
Accepted: December 6, 2017
Article in press: December 7, 2017
Published online: December 28, 2017
Processing time: 89 Days and 1.6 Hours
Abstract

Despite surgical removal of tumors with portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients, early recurrence tends to occur, and overall survival (OS) periods remain extremely short. The role that hepatectomy may play in long-term survival for HCC with PVTT has not been established. The operative mortality of hepatectomy for HCC with PVTT has also not been reviewed. Hence, we reviewed recent literature to assess these parameters. The OS of patients who received hepatectomy in conjunction with multidisciplinary treatment tended to be superior to that of patients who did not. Multidisciplinary treatments included the following: preoperative radiotherapy on PVTT; preoperative transarterial chemoembolization (TACE); subcutaneous administration of interferon-alpha (IFN-α) and intra-arterial infusion of 5-fluorouracil (5-FU) with infusion chemotherapy in the affected hepatic artery; cisplatin, doxorubicin and 5-FU locally administered in the portal vein; and subcutaneous injection of IFN-α, adjuvant chemotherapy (5-FU + Adriamycin) administration via the portal vein with postoperative TACE, percutaneous isolated hepatic perfusion and hepatic artery infusion and/or portal vein chemotherapy. The highest reported rate of operative mortality was 9.3%. In conclusion, hepatectomy for patients affected by HCC with PVTT is safe, has low mortality and might prolong survival in conjunction with multidisciplinary treatment.

Keywords: Hepatocellular carcinoma; Portal vein tumor thrombus; Hepatectomy; Multidisciplinary treatment; Operative mortality

Core tip: Hepatocellular carcinoma (HCC) is characterized by early formation of portal vein tumor thrombus (PVTT). Even after surgical removal of the tumors with PVTT in HCC patients, early recurrence has been frequently reported due to intrahepatic metastasis from PVTT. There have been reports of long-term survival after hepatectomy in patients with macroscopic PVTT. The operative mortality of major hepatectomy for HCC patients with macroscopic PVTT has not been well documented or discussed. To this end, we reviewed recent literature on the significance of hepatectomy in HCC with macroscopic PVTT with respect to the long-term survival and mortality.