Nevarez Nicole M, Yopp Adam C
Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
J Hepatocell Carcinoma. 2021 Jul 28;8:851-860. doi: 10.2147/JHC.S291530. eCollection 2021.
Portal vein tumor thrombus (PVTT) remains a common presentation in patients with hepatocellular carcinoma (HCC). Approximately 30-50% of patients newly diagnosed with HCC will present with a concomitant PVTT. Current guidelines recommend systemic therapy for treatment of HCC with PVTT. Real-world application of partial hepatectomy in HCC patients with PVTT has increased over the past two decades, as perioperative complications have declined. However, it is unclear if there is an association between the extent of PVTT and overall survival and rates of recurrence and whether the perioperative morbidity outweighs these potential benefits. Partial hepatectomy with en bloc resection of PVTT in second-order branches and distal can offer significant benefits in carefully selected patients; however, once the HCC-associated PVTT extends into first-order portal venous branches or more proximal into the superior mesenteric vein, the risks of surgical resection outweigh the benefits. The aim of this review is to determine which patients with HCC presenting with PVTT benefit from surgical resection. We will discuss the classification systems of PVTT and review both outcome and perioperative measures in patients undergoing partial hepatectomy with extirpation of HCC-related PVT.
门静脉癌栓（PVTT）仍是肝细胞癌（HCC）患者的常见表现。新诊断为HCC的患者中，约30%-50%会伴有PVTT。目前的指南推荐对伴有PVTT的HCC进行全身治疗。在过去二十年中，随着围手术期并发症的减少，HCC合并PVTT患者行肝部分切除术的实际应用有所增加。然而，尚不清楚PVTT的范围与总生存期、复发率之间是否存在关联，以及围手术期发病率是否超过这些潜在益处。对二级分支及远端PVTT进行整块切除的肝部分切除术，在精心挑选的患者中可带来显著益处；然而，一旦HCC相关的PVTT延伸至一级门静脉分支或更靠近肠系膜上静脉近端，手术切除的风险就会超过益处。本综述的目的是确定哪些伴有PVTT的HCC患者能从手术切除中获益。我们将讨论PVTT的分类系统，并回顾接受肝部分切除术切除HCC相关门静脉癌栓患者的预后及围手术期指标。
