| Treatment strategy for hepatocellular carcinoma with major portal vein or inferior vena cava invasion: a single institution experience. | |
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MedLine Citation:
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PMID: 21530845 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: The prognosis of patients with hepatocellular carcinoma (HCC) invading the main trunk of the portal vein and the inferior vena cava is dismal. The best strategy for treatment is not well known. STUDY DESIGN: We retrospectively reviewed the medical records of 641 patients treated for HCC between 1990 and June 2009. Eighty-four (13%) of these patients had HCC, with a tumor thrombus invading the main trunk or the first-order branch of the portal vein, or the inferior vena cava. Thirty-four patients underwent hepatectomy and 50 patients underwent transcatheter arterial chemoembolization (TACE). We specifically focused on these 34 patients to describe our results of surgical treatment for advanced HCC. RESULTS: Among the 34 patients who underwent hepatectomy, preoperative TACE was performed in 15 patients. Six patients were identified as having a tumor size reduction or necrosis of 50% or higher (TE3) by TACE. The median operative duration was 355 minutes. Postoperative morbidity and mortality rates were 44% and 2.9%, respectively. The 5-year survival rate after hepatectomy was 20%, which was better than that of patients after TACE alone. The response after preoperative TACE (hazard ratio 4.65; 95% CI, 1.39 to 15.5) and tumor diameter (hazard ratio 2.78; 95% CI, 1.16 to 6.64) were identified as significant favorable preoperative prognostic factors for survival using the multivariable Cox model. Patients with tumors smaller than 10 cm and TE3 effect had a more favorable survival than patients with tumors 10 cm or larger and who did not have a good TACE outcome. CONCLUSIONS: A combination of aggressive surgical treatment and effective preoperative TACE treatment for HCC with major vascular invasion may be beneficial for selected patients. |
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Authors:
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Hiroyuki Yoshidome; Dan Takeuchi; Fumio Kimura; Hiroaki Shimizu; Masayuki Ohtsuka; Atsushi Kato; Katsunori Furukawa; Hideyuki Yoshitomi; Masaru Miyazaki |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of the American College of Surgeons Volume: 212 ISSN: 1879-1190 ISO Abbreviation: J. Am. Coll. Surg. Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-05-02 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9431305 Medline TA: J Am Coll Surg Country: United States |
Other Details:
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Languages: eng Pagination: 796-803 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011. Published by Elsevier Inc. |
Affiliation:
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Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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