Jung Hyemin, Lee Kuhn Uk, Shin Woo Young, Ahn Hyuk
Department of Surgery, Seoul National University Hospital, Seoul, Korea.
Hepatogastroenterology. 2011 Sep-Oct;58(110-111):1694-9. doi: 10.5754/hge10653. Epub 2011 Jul 15.
BACKGROUND/AIMS: Advanced hepatocellular carcinoma with either an invasion of the inferior vena cava or thrombosis is rare, and its prognosis is extremely poor. There is no established treatment. The purpose of this study was to evaluate the efficacy of surgical resection and its prognosis in 5 recent cases.
From January 2005 to December 2008, 5 patients diagnosed with advanced hepatocellular carcinoma with inferior vena cava invasion and/or thrombosis underwent surgical resection. These patients were retrospectively reviewed.
The mean age at diagnosis was 54 years. There were 4 men and 1 woman. According to the Child-Pugh classification, all patients were class A. One case had 2 hepatic masses, and the others had a solitary hepatic mass. The mean tumor size was 5.53cm. All 5 patients underwent partial hepatectomy and inferior vena cava resection or thrombosis removal. Among these, 4 cases needed a cardiopulmonary bypass. Four patients survived and 1 patient expired at the point of analyzing. Four cases experienced recurrences. The mean disease-free survival time was 19.6 months. One patient has been followed-up for 43 months without any recurrences up to now.
Concurrent en-bloc resection of the liver and inferior vena cava for progressive HCC accompanying IVC invasion or thrombosis can be considered as a curative treatment.
背景/目的：侵犯下腔静脉或伴有血栓形成的晚期肝细胞癌较为罕见，其预后极差。目前尚无成熟的治疗方法。本研究旨在评估近期5例此类患者手术切除的疗效及其预后。
2005年1月至2008年12月，5例诊断为侵犯下腔静脉和/或伴有血栓形成的晚期肝细胞癌患者接受了手术切除。对这些患者进行回顾性分析。
确诊时的平均年龄为54岁。男性4例，女性1例。根据Child-Pugh分级，所有患者均为A级。1例有2个肝肿块，其余患者有单个肝肿块。平均肿瘤大小为5.53cm。所有5例患者均接受了肝部分切除术及下腔静脉切除术或血栓清除术。其中4例需要体外循环。在分析时，4例患者存活，1例患者死亡。4例出现复发。平均无病生存期为19.6个月。1例患者随访43个月，至今无任何复发。
对于伴有下腔静脉侵犯或血栓形成的进展期肝癌，同期整块切除肝脏和下腔静脉可被视为一种根治性治疗方法。
