Pesi Benedetta, Ferrero Alessandro, Grazi Gianluca L, Cescon Matteo, Russolillo Nadia, Leo Francesca, Boni Luca, Pinna Antonio D, Capussotti Lorenzo, Batignani Giacomo
Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy.
Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
Am J Surg. 2015 Jul;210(1):35-44. doi: 10.1016/j.amjsurg.2014.09.041. Epub 2015 Mar 28.
The role of liver resection (LR) of hepatocellular carcinoma with macroscopic vascular thrombosis (MVT) remains controversial. The aim of this study is to evaluate whether the presence of MVT should still be considered a contraindication for LR.
Retrospective study was carried out on 62 patients who underwent LR and thrombectomy for hepatocellular carcinoma complicated by MVT. Of the 62 patients, 15 (36.5%) had tumor thrombus (TT) in the peripheral portal vein (Vp1), 5 (12.2%) in second branch (Vp2), and 21 (51.3%) in the first branch/portal vein trunk (Vp3), while on the hepatic/cava vein side, 8 (12.9%) had TT in the main trunk of the hepatic veins (Vv2) and 3 (4.8%) had TT reaching the vena cava/right atrium (Vv3).
Perioperative major morbidity was 14.5%, while in-hospital mortality was 4.8%. Overall, 1, 3, and 5-year survival rates were 53.3%, 30.1%, and 20%, and disease-free survival rates were 31.7%, 20.8%, and 15.6%, respectively. There were no differences in survival about the MVT localized in Vp1, Vp2, or Vp3 (P = .77), while we found a statistical trend between patients with Vv2 and Vv3 (P = .06).
Surgical resection seems to be justified in these patients, and the presence of MVT should no longer be considered an absolute contraindication for LR.
肝切除（LR）治疗伴有肉眼可见血管血栓形成（MVT）的肝细胞癌的作用仍存在争议。本研究的目的是评估MVT的存在是否仍应被视为LR的禁忌证。
对62例行LR及血栓切除术治疗合并MVT的肝细胞癌患者进行回顾性研究。62例患者中，15例（36.5%）肿瘤血栓（TT）位于门静脉外周分支（Vp1），5例（12.2%）位于二级分支（Vp2），21例（51.3%）位于一级分支/门静脉主干（Vp3）；而在肝静脉/腔静脉侧，8例（12.9%）TT位于肝静脉主干（Vv2），3例（4.8%）TT延伸至腔静脉/右心房（Vv3）。
围手术期主要并发症发生率为14.5%，住院死亡率为4.8%。总体而言，1年、3年和5年生存率分别为53.3%、30.1%和20%，无病生存率分别为31.7%、20.8%和15.6%。位于Vp1、Vp2或Vp3的MVT患者生存率无差异（P = 0.77），但我们发现Vv2和Vv3患者之间存在统计学趋势（P = 0.06）。
对这些患者进行手术切除似乎是合理的，MVT的存在不应再被视为LR的绝对禁忌证。
