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Orthotopic liver transplantation for patients with hepatocellular carcinoma complicated by portal vein tumor thrombi.

BACKGROUND
Orthotopic liver transplantation (OLT) has been the valuable treatment of choice for patients with hepatocellular carcinoma (HCC). As the number of patients with portal vein tumor thrombi (PVTT) increases, most transplant centers become suspicious of the exact effect of the operation which has been accepted as a radical method. This study was designed to evaluate the clinical effects of OLT for patients with HCC associated with PVTT.


METHODS
The follow-up of 24 patients with HCC complicated by PVTT who had received OLT (transplant group) from January 1999 to March 2003 was compared to that of 27 patients undergoing routine hepatic resection (resection group) and 59 patients without surgical treatment (non-surgical group).


RESULTS
The perioperative mortality was zero for the transplant group. The 6-month, 1-year, and 2-year overall survival rates were 66.7%, 29.5% and 23.6% for the transplant group, 33.3%, 22.2% and 14.8% for the resection group (P=0.0335), and 42.1%, 24.4% and 4.1% for the non-surgical group, respectively (P=0.0316). The tumor free survival rates of recipients at 6-month, 1-year, and 2-year were 51.5%, 23.2% and zero, respectively. During the period of follow-up, the overall post-transplant intrahepatic recurrence or extrahepatic metastasis rate was 66.7% for the transplant group.


CONCLUSION
OLT is an effective but palliative treatment modality for patients with HCC associated with PVTT followed by a prolonged survival but a poor tumor free survival rate.