Hepatic Resection With Thrombectomy in the Treatment of Hepatocellular Carcinoma Associated With Macrovascular Invasion

Abstract

IntroductionMacrovascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) is a very poor prognostic factor. Treatment in such cases is still a matter of debate. The goal of this study is to assess short- and long-term results of liver resection and thrombectomy in a series of patients with HCC and MVI. MethodsRetrospective cohort study of patients who underwent liver resection for HCC in the period 2007–2015 (n = 120). Of all the patients, 108 did not have MVI, while 12 presented with MVI: 1 patient in the common portal vein (Vp4), 8 patients in first-order portal branches (Vp3), 1 patient in a sectorial branch (Vp2), 1 patient in a segmental branch (Vp1); another patient presented with tumor thrombus in a main hepatic venous branch in the confluence with the vena cava (Vv2). ResultsPatients with MVI needed major hepatic resection more frequently than patients without MVI (83.3% vs 25.9%, P < .0001), with no differences in postoperative mortality or severe morbidity. Patients with MVI required a longer operative time and developed more frequently postoperative ascites (33.3% vs 9.3%, P = .034).Global survival at 1, 3 and 5 years was 66.7%, 33.3% and 22.2% in patients with IMV, and 90.7%, 72.4% and 52.2% in patients without IMV (P = .009), respectively. ConclusionsHepatectomy associated with thrombectomy might be justified in a selected group of patients with HCC and MVI, offering a potential benefit in survival with acceptable morbidity.