JOURNAL OF SURGICAL ONCOLOGY 101, 7, 557 - 563 (2010).
Strategy of Treatment for Hepatocellular Carcinomas With Vascular Infiltration in Patients Undergoing Hepatectomy
Atsushi Nanashima , Syuuichi Tobinaga , Masaki Kunizaki , Satoshi Miuma , Naota Taura , Hiroaki Takeshita , Shigekazu Hidaka , Terumitsu Sawai , Kazuhiko Nakao , Takeshi Nagayasu
Background and Objectives: Vascular infiltration (VI) is an important prognostic factor for hepatocellular carcinoma (HCC) and predictive parameters are necessary to preoperatively decide treatment strategies in patients with HCC. Methods: Relationships between presence and degree of VI in the portal and hepatic veins and bile duct, and post-hepatectomy survival were examined in 271 HCC patients who underwent hepatectomy. Results: VI was observed in 81 patients (30%). Disease-free and overall survival rates was significantly lower in patients with VI than in patients without VI, and became poorer according to the degree of infiltration (P < 0.01). Multiple, increased size, non-meeting of Milan criteria, irregular macroscopic findings and increased PIVKA-II levels were associated with degree of VI in portal vein (P < 0.01). Increased size and increased PIVKA-II level were associated with degree of VI in hepatic vein (P < 0.05). Non-meeting of Milan criteria was associated with degree of infiltration in bile duct (P = 0.034). Survival was significantly better following anatomical resection than with non-anatomical resection and, furthermore, survival was better with surgical margins >5 mm than with shorter margins in patients who underwent non-anatomical resection. Conclusion: Adequate extent of operative procedures, but not limited resection with short margins, is useful when predictive parameters associated with VI are observed. J. Surg. Oncol. 2010;101:557-563. (C) 2010 Wiley-Liss, Inc.