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Hepatic Resection for Hepatocellular Carcinoma with Tumor Thrombus in the Major Portal Vein

Background: The prognosis of hepatocellular carcinoma (HCC) with tumor thrombus in the major portal vein has been extremely poor. We investigated the outcome of hepatic resection in HCC with major portal vein tumor thrombus (PVTT). Methods: We retrospectively evaluated 52 consecutive patients who underwent hepatic resection for HCC with tumor thrombi in the first branch or trunk of the portal vein. Factors related to disease-free survival (DFS) and overall survival (OS) were analyzed. Results: The median DFS and OS times were 8.9 and 27.6 months for the whole cohort, respectively. Multiple tumors (hazard ratio 2.12; 95% CI 1.11-4.33; p = 0.023), positive surgical margins (hazard ratio 2.45; 95% CI 1.19-4.81; p = 0.016), and non-adjuvant hepatic arterial infusion chemotherapy (HAIC; hazard ratio 2.07; 95% CI 1.11-3.90; p = 0.023) were independent risk factors for DFS. Non-adjuvant HAIC (hazard ratio 1.84; 95% CI 1.01-3.37; p = 0.047) was an independent risk factor for OS. Conclusions: Macroscopically curative resection seems to be of benefit to HCC patients with PVTT, even with tumor thrombi in the first branch or trunk of the portal vein. Adjuvant postoperative HAIC might improve DFS and OS in such patients.