Reappraisal of Evidence of Microscopic Portal Vein Involvement by Hepatocellular Carcinoma Cells with Stratification of Tumor Size

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2014 Oct 2

PMID 25270343

Citations 9

Authors

Yuesi Zhong

Meihai Deng

Ruiyun Xu

Affiliations

Soon will be listed here.

Abstract

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death internationally, it is necessary to reappraise evidences of HCC cells involving the portal vein, especially considering tumor size.

Materials And Methods: Histopathological evidence and dynamic evidences of radiology and cytology from publication were collected and analyzed.

Results: Frequencies of microscopic portal vein involvement (MPVI) and microscopic intrahepatic metastasis (MIM) in resected specimens with single nodule HCC were lower than that of multi nodule HCC, although not significantly. Early HCC (≤1.5 cm) was with extremely low to 0 frequencies of MPVI and MIM. HCC >5 cm showed a tendency of flowing HCC cells into portal vein, which was coincident with significantly high frequency (64.1 %) of MPVI for HCC >5 cm. There were no significant difference of frequencies of MPVI and MIM between groups of tumor ≤2, ≤3, and ≤5 cm.

Conclusions: Single nodule HCC >5 cm needs anatomic resection and the root of portal vein should be firstly ligated because of tendency of flowing HCC cells into portal vein. For single nodule HCC ≤2 cm, there was a risk of about 16.2 % of MPVI, and a risk of about 16.2-26.4 % of MPVI for those single nodule HCC ≤5 cm, however, there was a risk of extremely low to 0 of MPVI for early HCC (≤1.5 cm). Surgeons have to balance liver reserve and risk of MPVI for HCC ≤5 cm before deciding anatomic or nonanatomic resection.

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References

Kanai T, Hirohashi S, Upton M, Noguchi M, Kishi K, Makuuchi M . Pathology of small hepatocellular carcinoma. A proposal for a new gross classification. Cancer. 1987; 60(4):810-9. DOI: 10.1002/1097-0142(19870815)60:4<810::aid-cncr2820600417>3.0.co;2-1. View

Shindoh J, Hasegawa K, Inoue Y, Ishizawa T, Nagata R, Aoki T . Risk factors of post-operative recurrence and adequate surgical approach to improve long-term outcomes of hepatocellular carcinoma. HPB (Oxford). 2012; 15(1):31-9. PMC: 3533710. DOI: 10.1111/j.1477-2574.2012.00552.x. View

Sheu J, SUNG J, Chen D, Lai M, Wang T, Yu J . Early detection of hepatocellular carcinoma by real-time ultrasonography. A prospective study. Cancer. 1985; 56(3):660-6. DOI: 10.1002/1097-0142(19850801)56:3<660::aid-cncr2820560338>3.0.co;2-f. View

Davila J, El-Serag H . Racial differences in survival of hepatocellular carcinoma in the United States: a population-based study. Clin Gastroenterol Hepatol. 2006; 4(1):104-10. View

Adachi E, Maeda T, Kajiyama K, Kinukawa N, Matsumata T, Sugimachi K . Factors correlated with portal venous invasion by hepatocellular carcinoma: univariate and multivariate analyses of 232 resected cases without preoperative treatments. Cancer. 1996; 77(10):2022-31. DOI: 10.1002/(SICI)1097-0142(19960515)77:10<2022::AID-CNCR9>3.0.CO;2-S. View

Yamamoto M, Takasaki K, Yagawa A, Tsugita T, Nakagawa M, Aruga A . [Cancer cells in the portal and hepatic veins of resected specimens of hepatocellular carcinomas]. Gan No Rinsho. 1990; 36(12):2123-5. View

Ercolani G, Grazi G, Ravaioli M, Del Gaudio M, Gardini A, Cescon M . Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg. 2003; 237(4):536-43. PMC: 1514472. DOI: 10.1097/01.SLA.0000059988.22416.F2. View

Liu J, Chen P, Asch S, Busuttil R, Ko C . Surgery for hepatocellular carcinoma: does it improve survival?. Ann Surg Oncol. 2004; 11(3):298-303. DOI: 10.1245/aso.2004.03.042. View

Dahiya D, Wu T, Lee C, Chan K, Lee W, Chen M . Minor versus major hepatic resection for small hepatocellular carcinoma (HCC) in cirrhotic patients: a 20-year experience. Surgery. 2009; 147(5):676-85. DOI: 10.1016/j.surg.2009.10.043. View

10.

Shimada S, Kamiyama T, Yokoo H, Wakayama K, Tsuruga Y, Kakisaka T . Clinicopathological characteristics and prognostic factors in young patients after hepatectomy for hepatocellular carcinoma. World J Surg Oncol. 2013; 11:52. PMC: 3599395. DOI: 10.1186/1477-7819-11-52. View

11.

Sumie S, Kuromatsu R, Okuda K, Ando E, Takata A, Fukushima N . Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors. Ann Surg Oncol. 2008; 15(5):1375-82. DOI: 10.1245/s10434-008-9846-9. View

12.

Takayama T, Makuuchi M . Intraoperative ultrasonography and other techniques for segmental resections. Surg Oncol Clin N Am. 1996; 5(2):261-9. View

13.

Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M . Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005; 242(2):252-9. PMC: 1357731. DOI: 10.1097/01.sla.0000171307.37401.db. View

14.

Duffy J, Hiatt J, Busuttil R . Surgical resection of hepatocellular carcinoma. Cancer J. 2008; 14(2):100-10. DOI: 10.1097/PPO.0b013e31816a5c1f. View

15.

Tinkle C, Haas-Kogan D . Hepatocellular carcinoma: natural history, current management, and emerging tools. Biologics. 2012; 6:207-19. PMC: 3421475. DOI: 10.2147/BTT.S23907. View

16.

Takeishi K, Shirabe K, Muto J, Toshima T, Taketomi A, Maehara Y . Clinicopathological features and outcomes of young patients with hepatocellular carcinoma after hepatectomy. World J Surg. 2011; 35(5):1063-71. DOI: 10.1007/s00268-011-1017-7. View

17.

Yamanaka N, Okamoto E, Fujihara S, Kato T, Fujimoto J, Oriyama T . Do the tumor cells of hepatocellular carcinomas dislodge into the portal venous stream during hepatic resection?. Cancer. 1992; 70(9):2263-7. DOI: 10.1002/1097-0142(19921101)70:9<2263::aid-cncr2820700909>3.0.co;2-m. View

18.

Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S . Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003; 38(2):200-7. DOI: 10.1016/s0168-8278(02)00360-4. View

19.

Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Matsushita M, Todo S . The impact of anatomical resection for hepatocellular carcinoma that meets the Milan criteria. J Surg Oncol. 2009; 101(1):54-60. DOI: 10.1002/jso.21414. View

20.

Sasaki A, Iwashita Y, Shibata K, Ohta M, Kitano S, Mori M . Preoperative transcatheter arterial chemoembolization reduces long-term survival rate after hepatic resection for resectable hepatocellular carcinoma. Eur J Surg Oncol. 2006; 32(7):773-9. DOI: 10.1016/j.ejso.2006.04.002. View