Surgical Treatment Of Hepatocellular Carcinoma With Hepatic Vein/Inferior Vena Cava Tumor Thrombosis

ObjectiveIt aims to Summarizing the curative effect of surgical treatment of hepatocellular carcinoma with hepatic vein / inferior vena cava tumor thrombus.MethodsWe retrospectively analyzed the clinical and pathological data of twenty five case for hepatocellular carcinoma(HCC)with hepatic vein/inferior vena cava tumor thrombosis(HVTT/IVCTT)patients undergoing surgical treatment in the department of hepatobiliary surgery at Fujian Provincial Hospital from June 2011 to June 2017.In all cases,enhanced CT or enhanced MRI scans were performed before surgery to clarify the location of HCC and HVTT/IVCTT.There were fifteen patients with HVTT and ten patients with IVCTT.For patients with HVTT,hemisection or partial hepatectomy combined hemisection was performed,and the tumor emboli with lesion was removed in one piece.For patients with IVCTT,three types were classified according to location of the tumor embolus in the inferior vena cava.Among them,five cases of type I were treated with hepatectomy and axillary total hepatic flow occlusion and inferior vena cava incision and thrombectomy.Four patients with type II hepatic resection combined with supra-orbital total hepatic artery occlusion and inferior vena cava cutting.The thrombectomy was performed;in the case of type III,one patient underwent hepatectomy with a right atrium and inferior vena cava to remove the suppository.The preoperative basic data,intraoperative conditions,postoperative complications,mortality,and recurrence of twenty five patients were counted.RusultsLiver resection was performed in fifteen patients of HCC with HVTT,including three cases of left hemihepatectomy,four cases of right hemihepatectomy,five cases of hemihepatectomy combined with local resection,two cases of local hepatectomy,and one case of right hepatic trifoliate combined with local resection.The ten patients of HCC with IVCTT underwent hepatectomy combined with inferior vena cava incision and thrombectomy,including two cases of left lateral lobectomy,one case of left hemihepatectomy,one case of enlarged left hemihepatectomy,and six cases of right hemihepatectomy.In IVCTT group,the axillary total hepatic flow occlusion time was 5-33 min.The intraoperative blood loss of HVTT(n=15)was 880±677 ml,and that of IVCTT(n=10)was 1150±808 ml.One patient had chest and ascites improved after puncture and drainage,one patient experienced septic shock,improved after anti-infective treatment,and two cases of perioperative death after operation.The median tumor free survival of total disease in twenty three patients was 5 months.The median tumor free survival of HVTT group and IVCTT group was 5 months and 3 months.The median overall survival time after operation for the twenty three patients was 16 months,and the median survival time for the HVTT and IVCTT groups was 14 months and 17 months.There was no significant difference in tumor-free survival and overall survival between the two groups.The 1-,2-,and 3-year survival rates of twenty three patients were 56.5%,21.7%,and 8.7%.Five patients had long-term tumor-free survival,and three of them were treated with preventive Transcatheter arterial chemoembolization.One patient received sorafenib after surgery,and the five patients tumor-free survival time was 16 to 44 months.There are still 4 patients survived.ConclusionFor patients with HCC with HVTT/IVCTT who have good liver function,focused lesions resection,and no distant metastasis,surgical treatment should be the best choice.The patients of HCC with HVTT/IVCTT who have recurrence and metastasis after surgery,appropriate methods should be selected for active treatment under the conditions permitting.