Background/aims: Highly extended liver surgery for advanced hepatocellular carcinoma with tumor thrombi in the portal vein was reconfirmed from the viewpoint of the risk of operation, actual effect on prolongation of the life time, and the beneficial effects.
Material and methods: Sixty-two hepatocellular carcinoma (HCC) patients with tumor thrombi in the trunk or first branch of the portal vein (PV thrombi) were surgically treated by hepatic resection with removal of the PV thrombi and by postoperative transcatheter arterial embolization (TAE), while 38 HCC patients with PV thrombi were conservatively treated due to deleterious liver function and/or extensive spread of carcinoma.
Results: The mean and median survival time of 44 patients who were surgically treated and survived more than 60 POD were 900.5 and 305 days, respectively. By contrast, these values in 38 conservatively treated patients were 199.6 and 90 days, respectively. The extended surgical operation had few serious adverse effects on biochemical functions of the liver and beneficial effects on portal hypertension and related hypersplenism.
Conclusions: Although the most critical problems were postoperative liver failure and early recurrence, extended surgical treatment should be encouraged for the prolongation of life span and quality of life, when HCC are relatively small and the remnant liver is normal or only fibrotic.