Liver resection in hepatocellular carcinoma with venous infiltration

Objectives This study evaluates surgical cases from the past decade involving patients with suspected venous thrombosis (portal vein, hepatic veins, vena cava), hepatocellular carcinoma, and surgical intervention. Methods A retrospective analysis used data from the University Hospital Frankfurt from January 2011 to February 2023. Clinical data were extracted from electronic health records, including demographic information, tumor characteristics, treatment approaches and postoperative outcome. Statistical analysis was performed using SPSS. Results A total of eight patients were included. The collected data provided insights into the types of vascular invasion, 37.5 % pathological venous infiltration, 37.5 % with portal vein thrombosis and 25 % with intrahepatic vein and atrial tumor thrombus. Surgical interventions included 25 % left and 37.5 % right hemihepatectomies. 37.5 % of surgeries involved thrombus resection. Postoperative complications were Grade IIIa 25 %, Grade IIIb 12.5 % and Grade IVb 37.5 % according to the Clavien-Dindo (CD) classification. Long-term follow-up revealed a Grade V complication in one patient. The median overall survival (OS) was 4.95 years post-surgery. The respective 1-, 3- and 5-year survival rates were 87.5 , 58.3 and 38.9 %. The disease-free survival (DFS) was 5 months in patients 1–6 and the progression-free survival (PFS) in patients 7 and 8 was 3.7 and 3.63 months. Conclusions This study highlights the complexities and potential benefits of surgical intervention in patients with HCC and venous thrombosis. Despite the small sample size, the findings contribute valuable information for refining surgical indications and improving interdisciplinary decision-making processes. Surgery in this patient population is feasible with 87.5 % 1-year survival rate.