Department of Gastroenterological Surgery 1, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Japan.
World J Surg Oncol. 2013 Oct 5;11:259. doi: 10.1186/1477-7819-11-259.
The prognosis for advanced hepatocellular carcinoma (HCC) with tumor thrombi in the inferior vena cava (IVC) or right atrium (RA) is poor, and there is no established effective treatment for this condition. Thus study aimed to evaluate the efficacy of surgical resection and prognosis after surgery for such cases.
Between January 1990 and December 2012, 891 patients underwent hepatectomy for HCC at our institution. Of these, 13 patients (1.5%) diagnosed with advanced HCC with tumor thrombi in the IVC or RA underwent hepatectomy and thrombectomy. Data detailing the surgical outcome were evaluated and recurrence-free and overall survival rates were calculated using the Kaplan-Meier method.
Seven patients had an IVC thrombus and six had an RA thrombus. Extra-hepatic metastasis was diagnosed in 8 of 13 patients. Surgical procedures included three extended right lobectomies, three extended left lobectomies, five right lobectomies, and two sectionectomies. Right adrenal gland metastases were excised simultaneously in two patients. All IVC thrombi were removed under hepatic vascular exclusion and all RA thrombi were removed under cardiopulmonary bypass (CPB). Four patients (30.8%) experienced controllable postoperative complications, and there was no surgical mortality. The mean postoperative hospital stay for patients with IVC and RA thrombi was 23.6 ± 12.5 days and 21.2 ± 4.6 days, respectively. Curative resection was performed in 5 of 13 cases. The 1- and 3-year overall survival rates were 50.4%, and 21.0%, respectively, and the median survival duration was 15.3 months. The 1- and 3-year overall survival rates for patients who underwent curative surgical resection were 80.0% and 30.0%, respectively, with a median survival duration of 30.8 months. All patients who underwent curative resection developed postoperative recurrences, with a median recurrence-free survival duration of 3.8 months. The 1-year survival rate for patients who underwent noncurative surgery and had residual tumors was 29.2%, with a median survival duration of 10.5 months.
Aggressive surgical resection for HCC with tumor thrombi in the IVC or RA can be performed safely and may improve the prognoses of these patients. However, early recurrence and treatment for recurrent or metastatic tumors remain unresolved issues.
伴有下腔静脉（IVC）或右心房（RA）肿瘤血栓的晚期肝细胞癌（HCC）预后较差，目前对此类疾病尚无有效的治疗方法。因此，本研究旨在评估手术切除的疗效和术后预后。
1990 年 1 月至 2012 年 12 月期间，我院有 891 例 HCC 患者接受了肝切除术，其中 13 例（1.5%）诊断为伴有 IVC 或 RA 肿瘤血栓的晚期 HCC，接受了肝切除术和血栓切除术。详细评估了手术结果，并采用 Kaplan-Meier 法计算无复发生存率和总生存率。
7 例患者有 IVC 血栓，6 例患者有 RA 血栓。13 例患者中有 8 例诊断为肝外转移。手术方式包括 3 例扩大右半肝切除术、3 例扩大左半肝切除术、5 例右半肝切除术和 2 例节段切除术。2 例患者同时切除右肾上腺转移灶。所有 IVC 血栓均在肝血管阻断下取出，所有 RA 血栓均在心肺转流下取出。4 例（30.8%）患者术后出现可控并发症，无手术死亡。IVC 和 RA 血栓患者的术后平均住院时间分别为 23.6±12.5 天和 21.2±4.6 天。13 例患者中有 5 例获得根治性切除。1 年和 3 年总生存率分别为 50.4%和 21.0%，中位生存时间为 15.3 个月。根治性切除患者的 1 年和 3 年总生存率分别为 80.0%和 30.0%，中位生存时间为 30.8 个月。所有根治性切除患者均发生术后复发，无复发生存期的中位数为 3.8 个月。行非根治性手术且有肿瘤残留的患者 1 年生存率为 29.2%，中位生存时间为 10.5 个月。
积极的手术切除伴有 IVC 或 RA 肿瘤血栓的 HCC 是安全的，可能改善此类患者的预后。然而，早期复发和治疗复发性或转移性肿瘤仍是未解决的问题。
