Surgical Resection Versus Best Supportive Care for Resectable Hepatocellular Carcinoma Invading the First Branch of Portal Vein
Advances in surgical techniques have made it possible to remove all macroscopic tumors in
more hepatocellular carcinoma (HCC) patients with portal venous thrombus (PVTT). However,
the benefit of such surgery remains largely controversial. On one hand, many clinicians
believe that surgical resection offers the only chance for long term survival. Many studies
reported a median survival of 6-40 months after liver resection and thrombectomy, and some
cases achieved long term survival.On the other hand, the strength of evidences arising from
these studies was widely questioned because of their retrospective nature and study design.
Most of them were single arm cohort study. A few studies used control groups consisted of
patients with unresectable HCC and PVTT underwent transarterial chemoembolization. This led
to obvious selection bias. Because patients with unresectable HCC and PVTT have a much
poorer prognosis compared with resectable disease because of more widespread tumor focus and
less residual liver, even if their baseline characters are comparable.
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Ming Shi, MD.
Sun Yat-sen University
China: Ministry of Health