Abstracts
1999 Digestive Disease Week

# 2120 RESULT OF 18 RESECTED CASES OF ADVANCED HEPATOCELLULAR CARCINOMA WITH TUMOR THROMBI DEVELOPED IN THE MAIN PORTAL VEIN, INFERIOR VENA CAVA OR EXTRAHEPATIC BILE DUCT
Shuichi Fukuda, Koji Okuda, Mahiro Imamura, Eiji Tanaka, Ichiro Imamura, Naoyuki Saito, Hisafumi Kinoshita, Dept of Surg Kurume Univ Sch of Medicine, Kurume Japan; Naofumi Eriguchi, Kurume Univ Sch of Medicine, Kurume Japan; Shigeaki Aoyagi, Dept of Surg Kurume Univ Sch of Medicine, Kurume Japan

Purpose: This study is aimed to evaluate the prognotic significance in surgical resection for advanced hepatocellular carcinoma(HCC) with tumor thrombi developed in the main portal vein, inferior vena cava or extrahepatic bile duct. Method:Eighteen resected cases of advanced HCC with tumor thrombi developed in either of the portal trunk or first branch of the portal vein(PV group), inferior vena cava(IVC group) or extrahepatic bile duct(EB group) were enrolled in this study. Result: Hospital death was not observed. The 3-year, 5-year and 10-year survival rates were 45.3%, 32.3%, 32.3%, respectively. There was no significant difference in survival concerning with tumor size, macroscopic type or histological differentiation. The 5-years survival rates were of PV, IVC and EB were 41.7%, 3.0% and 51.4%. The incidence of postoperative distal metastasis in IVC group was as high as 100%. Both of two cases with postoperative residual tumor thrombus died within six months postoperatively due to rapid progression of tumor thrombus. Five cases survived over five years after operation. The clinical profile and pathological findings of the five cases revealed four possible factors contributing to long-term survival as follows: 1.liver cirrhosis was not coexistent(80.0%), 2.intrahepatic metastasis was not coexistent at surgery(80.0%), 3.tumor thrombi were throughly removed (100%), 4.no recurrence, or even in recurrent cases, chemotherapy was beneficial(80.0%). Conclusion: 1.Resection of advanced HCC with tumor thrombi developed in the main portal vein, inferior vena cava or extrahepatic bile duct was performed safely, and demonstrated favorable prognosis. However, IVC showed poor prognosis as a result of high incidence of distal metastasis. 2.Removal of tumor thrombi without any residue and efficacious chemotherapy were inevitable for long-term survival in those advanced HCC cases.

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