Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.
Ann Surg Oncol. 2010 Aug;17(8):2073-80. doi: 10.1245/s10434-010-0940-4. Epub 2010 Feb 4.
The role of liver resection in patients with hepatocellular carcinoma (HCC) accompanying with portal vein tumor thrombus (PVTT) remains controversial. This article aimed to evaluate the significance of different location and extent of PVTT on surgical outcomes after liver resection for HCC.
A retrospective study was carried out on patients who underwent partial hepatectomy with or without portal thrombectomy for HCC with PVTT in a single tertiary center from January 2001 to December 2003. According to the extent, PVTT was divided into 4 types (I-segmental/sectoral branches of portal vein, II-left and/or right portal vein, III-main portal vein trunk, and IV-superior mesenteric vein).
A total of 406 patients with HCC and PVTT who underwent partial hepatectomy were studied. The complication rate and hospital mortality rate were 32.8 and 0.2%, respectively. After a median follow-up of 6.4 months, 128 patients (31.5%) died. The 1- and 3-year overall survival rates were 34.4 and 13.0%, respectively. The 1- and 3-year disease-free survival rates were 13.3 and 4.7%, respectively. Patients with PVTT located in the segmental, sectoral, or right and/or left portal veins (types I and II) showed significantly better survival than those with PVTT extended to the main trunk of the portal vein or the superior mesenteric vein (types III and IV).
Liver resection is justified in selected patients with PVTT located in the segmental or sectoral branches of the portal vein. However, surgical resection for PVTT involving the portal bifurcation or the main trunk is still controversial.
肝癌（HCC）合并门静脉癌栓（PVTT）患者行肝切除术的作用仍存在争议。本文旨在评估不同部位和程度的 PVTT 对 HCC 患者行肝切除术后手术结果的意义。
对 2001 年 1 月至 2003 年 12 月在一家三级中心行部分肝切除术伴或不伴门静脉血栓切除术的 HCC 合并 PVTT 患者进行回顾性研究。根据 extent，PVTT 分为 4 型（I-门静脉节段/扇段分支、II-左和/或右门静脉、III-主门静脉干、IV-肠系膜上静脉）。
共研究了 406 例 HCC 合并 PVTT 行部分肝切除术的患者。并发症发生率和住院死亡率分别为 32.8%和 0.2%。中位随访 6.4 个月后，128 例患者（31.5%）死亡。1 年和 3 年总生存率分别为 34.4%和 13.0%。1 年和 3 年无病生存率分别为 13.3%和 4.7%。PVTT 位于门静脉节段性、扇段性或右和/或左支（I 型和 II 型）的患者的生存情况明显优于 PVTT 延伸至门静脉主干或肠系膜上静脉（III 型和 IV 型）的患者。
在选择性的 PVTT 位于门静脉节段性或扇段性分支的患者中，肝切除术是合理的。然而，对于涉及门静脉分叉或主干的 PVTT 的手术切除仍存在争议。
