Objective To improve the prognosis of primary liver cancer with portal vein tumor thrombus （PVTT）， the progress of treatment for primary liver cancer with PVTT was reviewed. Methods The therapeutic approach and its efficacy for primary liver cancer with PVTT were summarized by literature search within recent years. Results PVTT is a common complication of primary liver cancer， the therapeutic approach are surgical resection， transcatheter arterial chemoembolization (TACE), intraportal venous therapy， radiotherapy， ablation therapy, molecular targeted therapy， etc. The excision rate for primary liver cancer with PVTT is low， the treatment is difficult and the outcome is dismal. It remains a poor prognosis at present， and the therapeutic effect need to be promoted. Conclusions The main treatment for primary liver cancer with PVTT should be surgical excision combine with other multidisciplinary comprehensive treatment to improve the survival in patients with PVTT， moreover， the therapeutic approach should be individualized and sequentially according to the patient’s condition and the type of PVTT.
Objective To compare the effect of two chemotherapeutic patterns after hepatectomy of hepatocellular carcinoma （HCC） with portal vein tumor thrombi（PVTT）. Methods The clinical data of 51 HCC patients with PVTT who were treated in our department from June 2006 to December 2011 were analyzed retrospectively. Fifty-one HCC patients with PVTT who were performed hepatectomy and treatment of antivirus and improve immune were divided into two groups according to chemotherapeutic patterns after operation： portal vein infusion drug deliver system （PVIDDS）group （n=19） and transcatheter arterial chemoembolization（TACE） group（n=32），and to compare the treatment effect of the two groups. Results The recurrence rate of 1-month, 1-year，3-year， and 5-year after operation in TACE group was 3.1%（1/32），46.9%（15/32），84.4%（27/32）， and 100%（32/32），respectively. And in PVIDDS group, which was 5.3%（1/19），52.6%（10/19），100%（19/19）， and 100%（19/19），respectively. There were no differences in recurrence rate of 1-month, 1-year, and 5-year after operation in two groups（P＞0.05）. Recurrence rate of 3-year after operation in TACE group was lower than that in PVIDDS group（P＜0.05）. There were no differences in medial survival time（17.1 months vs.15.9 months）， survival rate of 1-year（93.8% vs.94.7%） and 3-year（40.6% vs. 36.8%） after operation in TACE group and PVIDDS group（P＞0.05）. Survival rate of 5-year after operation in TACE group was higher than that in PVIDDS group（21.9% vs.0, P＜0.05）. The rate of complication in TACE group was lower than that in PVIDDS group（65.6% vs.94.7%，P＜0.05）. Conclusions If the HCC patients with PVTT could endure operation，surgical resection should be considered firstly，furthermore antivirus treatment, improving immune，and chemotherapy should be considered after operation. The effect of TACE is better than PVIDDS.
Objective To explore the curative effect of surgical treatment for primary liver cancer with portal vein tumor thrombus（PVTT）. Methods The clinical data of 227 patients who were performed surgical treatment because of primary liver cancer with PVTT were analyzed retrospectively. Results Two hundreds and seventeen cases were performed surgical resection, 14 cases died from postoperative complications. The median survival time was 17.7 months, and the l-, 2-, 3-, and 5-year survival rates were 61.9%, 37.2%, 21.7%, and 4.0% respectively. There were 40 cases with PVTT ofⅠtype, the l-, 2-, 3-, and 5-year survival rates were 82.3% , 61.7%, 38.6%, and 6.6% respectively，which was obviously higher than those with PVTT of Ⅱ type （n=129, 61.1%, 34.3%, 20.8%, and 5.3%） and PVTT of Ⅲ type （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. There were 84 cases whose PVTT and tumor were resected together, the l-, 2-, 3-, and 5-year survival rates were 67.3%, 43.2%, 28.1%, and 7.9% respectively，which were obviously higher than those patients whose PVTT were removed from cross-section of liver （n= 85, 65.1%, 38.8%, 22.3%, and 3.4%） and patients whose PVTT were removed by cutting the portal vein （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. The l-, 2-, 3-, and 5-year survival rates of 76 cases who received postoperative therapy of TACE/TAI were 75.3%, 53.2%, 33.1%, and 5.7% respectively, which were obviously higher than those patients who were not received any postoperative therapy （n=141, 54.8%, 29.1%, 15.9%, and 3.2%）, P＜0.05. Conclusions Surgical treatment is an effective treatment for primary liver cancer with PVTT. Surgery should strive for resecting the tumor and PVTT together, and postoperative therapy of TACE/TAI may have a favorable effect on the long term survival rate.