Resección hepática con trombectomía en el tratamiento del carcinoma hepatocelular con invasión vascular macroscópica / Hepatic resection with thrombectomy in the treatment of hepatocellular carcinoma associated with macrovascular invasión

Introducción: La invasión macrovascular (IMV) en los pacientes con carcinoma hepatocelular (CHC) es un factor de muy mal pronóstico. El tratamiento de estos casos es todavía controvertido. El objetivo de este estudio es valorar los resultados a corto y a largo plazo de la resección hepática asociada a trombectomía en una serie de pacientes con CHC asociado a IMV. Métodos: Estudio retrospectivo de cohortes en los pacientes sometidos a resección hepática por CHC durante el período 2007-2015 (n=120). Del total, 108 pacientes no presentaban IMV, mientras 12 presentaban al diagnóstico IMV: 1paciente presentaba IMV en la porta común (Vp4), 8pacientes en ramas portales de primer orden (Vp3), 1paciente en ramas sectoriales (Vp2), 1 paciente en ramas segmentarias (Vp1), y además 1paciente presentaba trombosis en una vena suprahepática principal hasta la entrada en vena cava (Vv2). Resultados: Los pacientes con IMV necesitaron con mayor frecuencia una hepatectomía mayor frente a los sin IMV (83,3% vs 25,9%, p < 0,0001), sin diferencias en cuanto a mortalidad y morbilidad grave postoperatoria. Los casos con IMV requirieron un tiempo operatorio más largo y desarrollaron con más frecuencia ascitis postoperatoria (33,3% vs 9,3%, p = 0,034). La supervivencia global a 1, 3 y 5 años fue del 66,7, del 33,3 y del 22,2%, respectivamente, en los pacientes con IMV, y del 90,7, del 72,4 y del 52,2% en el grupo sin IMV (p = 0,009). Conclusión: La hepatectomía asociada a trombectomía parece estar justificada en un grupo seleccionado de pacientes con CHC e IMV, pudiendo aportar un beneficio de supervivencia con una aceptable tasa de morbilidad

Introduction: Macrovascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) is a very poor prognostic factor. Treatment in such cases is still a matter of debate. The goal of this study is to assess short- and long-term results of liver resection and thrombectomy in a series of patients with HCC and MVI: Methods: Retrospective cohort study of patients who underwent liver resection for HCC in the period 2007-2015 (n=120). Of all the patients, 108 did not have MVI, while 12 presented with MVI: 1patient in the common portal vein (Vp4), 8 patients in first-order portal branches (Vp3), 1patient in a sectorial branch (Vp2), 1patient in a segmental branch (Vp1); another patient presented with tumor thrombus in a main hepatic venous branch in the confluence with the vena cava (Vv2). Results: Patients with MVI needed major hepatic resection more frequently than patients without MVI (83.3% vs 25.9%, P < .0001), with no differences in postoperative mortality or severe morbidity. Patients with MVI required a longer operative time and developed more frequently postoperative ascites (33.3% vs 9.3%, P = .034). Global survival at 1, 3 and 5years was 66.7%, 33.3% and 22.2% in patients with IMV, and 90.7%, 72.4% and 52.2% in patients without IMV (P = .009), respectively. Conclusions: Hepatectomy associated with thrombectomy might be justified in a selected group of patients with HCC and MVI, offering a potential benefit in survival with acceptable morbidity

Hepatic resection with thrombectomy in the treatment of hepatocellular carcinoma associated with macrovascular invasion. / Resección hepática con trombectomía en el tratamiento del carcinoma hepatocelular con invasión vascular macroscópica.

INTRODUCTION: Macrovascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) is a very poor prognostic factor. Treatment in such cases is still a matter of debate. The goal of this study is to assess short- and long-term results of liver resection and thrombectomy in a series of patients with HCC and MVI. METHODS: Retrospective cohort study of patients who underwent liver resection for HCC in the period 2007-2015 (n=120). Of all the patients, 108 did not have MVI, while 12 presented with MVI: 1patient in the common portal vein (Vp4), 8patients in first-order portal branches (Vp3), 1patient in a sectorial branch (Vp2), 1patient in a segmental branch (Vp1); another patient presented with tumor thrombus in a main hepatic venous branch in the confluence with the vena cava (Vv2). RESULTS: Patients with MVI needed major hepatic resection more frequently than patients without MVI (83.3% vs 25.9%, P<.0001), with no differences in postoperative mortality or severe morbidity. Patients with MVI required a longer operative time and developed more frequently postoperative ascites (33.3% vs 9.3%, P=.034). Global survival at 1, 3 and 5years was 66.7%, 33.3% and 22.2% in patients with IMV, and 90.7%, 72.4% and 52.2% in patients without IMV (P=.009), respectively. CONCLUSIONS: Hepatectomy associated with thrombectomy might be justified in a selected group of patients with HCC and MVI, offering a potential benefit in survival with acceptable morbidity.