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Surgery Today
Published in: Surgery Today 9/2017

01-09-2017 | Original Article

New macroscopic classification and back-flow thrombectomy for advanced hepatocellular carcinoma with portal vein tumor thrombus invading the contralateral second portal branch

Authors: Takumi Fukumoto, Masahiro Kido, Atsushi Takebe, Motofumi Tanaka, Hisoka Kinoshita, Kaori Kuramitsu, Shohei Komatsu, Daisuke Tsugawa, Tadahiro Goto, Sadaki Asari, Hirochika Toyama, Tetsuo Ajiki, Yonson Ku

Published in: Surgery Today | Issue 9/2017

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Abstract

Purpose

Patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) invading the portal trunk (Vp4) are poor surgical candidates because of the technical difficulties involved. To overcome the limitations, we developed a technique of back-flow thrombectomy (BFT) based on the inherent portal hemodynamics and the macroscopic form of PVTT.

Methods

Forty-six patients with multiple HCC and Vp4 PVTT underwent hepatectomy with tumor thrombectomy. We used the BFT to treat 24 patients, 18 of whom had PVTT in the contralateral second portal branch. The form of PVTT was classified macroscopically into the floating and expansive types.

Results

The rate of complete removal by BFT of PVTT in the contralateral second portal branch was 89%. The patency rates at the thrombectomy site in all 46 patients and in the 24 BFT patients, 3 months after hepatectomy were 93 and 90%, respectively. The median OS of all 46 patients was 15 months, with 1- and 3-year OS rates of 58.5 and 17.1%, respectively. The median OS of the 24 patients treated with BFT vs. the 22 not treated with BFT was 14 and 15 months, respectively.

Conclusions

BFT can expand the therapeutic time window for patients with HCC and deep-seated PVTT and may improve their survival.
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Metadata
Title
New macroscopic classification and back-flow thrombectomy for advanced hepatocellular carcinoma with portal vein tumor thrombus invading the contralateral second portal branch
Authors
Takumi Fukumoto
Masahiro Kido
Atsushi Takebe
Motofumi Tanaka
Hisoka Kinoshita
Kaori Kuramitsu
Shohei Komatsu
Daisuke Tsugawa
Tadahiro Goto
Sadaki Asari
Hirochika Toyama
Tetsuo Ajiki
Yonson Ku
Publication date
01-09-2017
Publisher
Springer Japan
Published in
Surgery Today / Issue 9/2017
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-017-1507-9

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