Significance of hepatic resection and adjuvant hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumor thrombus in the first branch of portal vein and the main portal trunk: a project study for hepatic surgery of the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery

Background The prognosis of hepatocellular carcinoma (HCC) with tumor thrombus in the major portal vein (PV) is extremely poor. The purpose of this study was to clarify the impact of hepatic resection for HCC with tumor thrombus in the major PV. Patients Four hundred patients undergoing macroscopic curative resection for HCC involving the first branch or trunk of the PV between 2001 and 2010 at the 22 institutions were enrolled. We examined the effect of adjuvant hepatic arterial infusion chemotherapy (HAIC) on prognosis and validated the prognostic index consisting of ascites, prothrombin activity, and maximal tumor diameter. Results Median survival time (MST) and 5‐year overall survival rate were 21.5 months and 25.7%. MST of HAIC group was longer than that of non‐HAIC group (28.1 months vs. 18.7 months, P = 0.0024). Significant prognostic factors for overall survival were PIVKA‐II, tumor diameter, and adjuvant HAIC. MST for patients with prognostic index 0, 1, 2, and 3 was 39.0, 21.1, 18.9, and 5.7 months, respectively (P = 0.005). Conclusions Macroscopic curative resection with adjuvant HAIC might provide better survival outcome. Furthermore, the prognostic index was useful to select adequate treatment modalities for patients with HCC with tumor thrombosis in the major PV. Highlight Hatano and colleagues examined survival outcomes after hepatic resection in 400 patients with hepatocellular carcinoma with tumor thrombus in the major portal vein. Significant prognostic factors were PIVKA‐II, tumor diameter, and adjuvant hepatic arterial infusion chemotherapy. Macroscopic curative resection with adjuvant hepatic arterial infusion chemotherapy might provide better survival outcomes.