A. Li1, M. Wu1 1Eastern Hepatobiliary Surgery Hospital,SMMU,Shanghai, SHANGHAI, China
Introduction: To investigate the differences in the surgical approaches for resection of hepatocellular carcinoma (HCC) with tumor thrombus was extending into the hepatic vein using occlusion of the suprahepatic inferior vena cava (IVC) with occlusion forceps.
Methods: Between January 2011 and December 2013, 21 patients diagnosed with advanced HCC with tumor thrombi in the hepatic vein underwent hepatectomy and thrombectomy. Peri- and postoperative morbidity and mortality rates were evaluated prospectively and analyzed.
Results:Mean age of the patients was 47 years. Median primary tumor size was 12.0±4.0cm. All HVTT were removed using occlusion of the suprahepatic IVC with Satinsky vascular clamp. Pringle’s maneuver time was 19 minutes (range 15 to 24 minutes). Mean time of occlusion of the suprahepatic IVC was 10 minutes (range 8 to 20 minutes). Mean intraoperative blood loss was 600 mL (range 300 to 2,000 mL). Postoperative complications were seen in 10% of patients (n=2), included pleural effusion (n=2). Median follow-up was 38 months (range 2 to 72 months). The 1- and 2-year overall survival (OS) rates were 57% and 4%, respectively, while the 1- and 2-year recurrence rates were 94% and 96%.
Conclusion: This study showed that using occlusion of the suprahepatic IVC, resection for HCC with tumor thrombi in the hepatic vein can be performed safely and thereby avoid embolus rupture of tumor thrombus and air embolism, and may improve the prognosis of these patients. This method is especially suitable for unexpected, intraoperatively detected hepatic vein tumor thrombus.