Hepatocellular carcinoma patients with left portal vein tumor thrombus may benefit from left hemi-hepatectomy with caudate lobectomy.

Abstract

To investigate the specific role of caudate lobectomy (CL) in liver resection for HCC with left portal vein tumor thrombus (PVTT) and the prognostic factors for survival in this group of patients. We reviewed all HCC patients with left PVTT who underwent liver resection in our medical unit January 2008 to September 2009. Patients were divided into two groups: those with (Group A) and without (Group B) CL. There were 30 patients included in this study, 20 without CL (66.7%) and 10 with CL (33.3%). The demographics and symptoms of presentation were comparable. There were no mobility and mortality in the perioperative period. Patients had a significantly higher 1- and 3-year OS rates in Group A compared to Group B (43% vs. 32%, p<0.001; 16% vs. 11%, p=0.013) and higher 1- and 3-year DFS rates (15% vs. 9.6%, p<0.001; 8% vs. 4.8%, p<0.001). Multivariate analysis for OS and DFS rates found that CL (p=0.020) and poorly differentiated HCC (p=0.001) were positive and negative prognostic factors, respectively. For HCC patients with left PVTT, left hemi-hepatectomy with CL has better OS and DFS rates and does not enhance the postoperative liver dysfunction risk.