It is well established that hepatocellular carcinoma carries a poorer prognosis when it invades the portal vein (PV). Nevertheless, many patients with involvement of a distal lobar PV still benefit from resection. However, the value of a hepatectomy when the tumor extends to the PV bifurcation has not been entirely defined. In the study by Wu and colleagues, 15 patients underwent PV resection for retrograde tumor extension to the PV bifurcation without occlusion of the main PV. This represented 4% of all resections performed by the authors for hepatocellular carcinoma during the period studied. It is not stated how many patients were deemed unsuitable for PV resection either prior to or during laparotomy; however, this is difficult to ascertain in a retrospective review. Preoperative angiography was performed routinely in these patients, but duplex ultrasonography may have provided comparable information at the hilus. Magnetic resonance or computed tomographic angiography will likely replace invasive investigation in the near future.
DeMatteo RP. An Appraisal of Liver and Portal Vein Resection for Hepatocellular Carcinoma With Tumor Thrombi Extending to Portal Bifurcation—Invited Critique. Arch Surg. 2000;135(11):1279. doi:10.1001/archsurg.135.11.1279