ABSTRACT
In patients with advanced hepatocellular carcinoma (HCC) presenting with vascular and/or biliary invasion, major hepatectomy is often indicated for curative resection. In HCC patients with portal vein tumor thrombus, limited anatomical resection such as sectionectomy is a possible alternative for a case of small size HCC with localized portal thrombus in the affected section of the cirrhotic liver. Invasion of the caudate lobe branch of the portal vein and hepatic functional reserve affect the selection of the operative procedure. In HCC patients with hepatic vein or I VC tumor thrombus, hepatectomy with hepatic venous thrombectomy or concomitant resection of the involved hepatic vein and/or I VC is indicated. Depending on the extent of tumor thrombus, we must discuss about the necessity of the active veno-veno bypass during total hepatic vascular exclusion. HCC patients with biliary invasion extending over the hepatic confluence often develop obstructive jaundice, accelerating deterioration in the functional reserve of the future remnant liver, especially in the cirrhotic patients. Thus, radical hepatectomy for patients with biliary tumor thrombi is rarely indicated due to the poor hepatic functional reserve. Immediate percutaneous transhepatic biliary drainage plays a key role in recovery of the impaired liver func tion. As most of a biliary tumor thrombus can be removed through choledochotomy, extrahepatic bile duct resection with bilioenterostomy is not required in many cases. Therefore, hepatobiliary resection with bilioenterosotmy should be avoided even for patients with HCC presenting with biliary tumor thrombus.
