Thématique :
- Foie
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
Journal of Hepatology
  2016 Nov;65(5):938-943  
  doi: 10.1016/j.jhep.2016.05.044  
  Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion  
  Kokudo T, Hasegawa K, Matsuyama Y, Takayama T, Izumi N, Kadoya M, Kudo M, Ku Y, Sakamoto M, Nakashima O, Kaneko S, Kokudo N  



The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not recommended. The aim of this study was to evaluate the survival benefit of LR for HCC patients with PVTT through the analysis of the data from a Japanese nationwide survey.


We analyzed data for 6474 HCC patients with PVTT registered between 2000 and 2007. Of these patients, 2093 patients who underwent LR and 4381 patients who received other treatments were compared. The propensity scores were calculated and we successfully matched 1058 patients (66.1% of the LR group).


In the Child-Pugh A patients, the median survival time (MST) in the LR group was 1.77years longer than that in the non-LR group (2.87years vs. 1.10years; p<0.001) and 0.88years longer than that in the non-LR group (2.45years vs. 1.57years; p<0.001) in a propensity score-matched cohort. A subgroup analysis revealed that LR provides a survival benefit regardless of age, etiology of HCC, tumor marker elevation, and tumor number. The survival benefit was not statistically significant only in patients with PVTT invading the main trunk or contralateral branch. In the LR group, the postoperative 90-day mortality rate was 3.7% (68 patients).


As long as the PVTT is limited to the first-order branch, LR is associated with a longer survival outcome than non-surgical treatment.

Question posée
Quel bénéfice de survie de la résection hépatique pour carcinome hépatocellulaire associé à l'invasion de la veine porte?
Question posée
Tant que la thrombose tumorale de la veine porte est limitée à la branche de premier ordre, la résection hépatique est associée à une survie plus longue que les résultats du traitement non chirurgical.

A méditer et utiliser lors de nos RCP de cancérologie.