Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitors
Abstract Background It is controversial whether patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) should undergo salvage surgery following the combination therapy of tyrosine kinase inhibitors (TKIs) and programmed cell death protein 1 (PD-1) inhibitors. This study...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-023-02291-1 |
| _version_ | 1827399637844099072 |
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| author | Tianyu Jiao Haowen Tang Wenwen Zhang Bingyang Hu Tao Wan Yinbiao Cao Ze Zhang Yafei Wang Junning Cao Mengqiu Cui Shichun Lu |
| author_facet | Tianyu Jiao Haowen Tang Wenwen Zhang Bingyang Hu Tao Wan Yinbiao Cao Ze Zhang Yafei Wang Junning Cao Mengqiu Cui Shichun Lu |
| author_sort | Tianyu Jiao |
| collection | DOAJ |
| description | Abstract Background It is controversial whether patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) should undergo salvage surgery following the combination therapy of tyrosine kinase inhibitors (TKIs) and programmed cell death protein 1 (PD-1) inhibitors. This study aimed to elucidate the efficiency and safety of salvage surgery following combination therapy, while also summarizing a novel surgical approach for Vp3/4 PVTT. Methods Between April 2019 and December 2022, a consecutive series of unresectable HCC patients with PVTT who received salvage surgery following combination therapy were enrolled. Evaluation included perioperative and long-term follow-up outcomes. The complete removal of Vp3/4 PVTT was achieved using a novel surgical approach characterized by “longitudinal incision and transverse suturing” and “angle-to-straight conversion”. Results Forty patients including 22 patients with Vp3 and 18 patients with Vp4 were included. Long-term follow-up showed similar rates of portal vein patency (Vp3: 95.5%, Vp4:94.4%, p = 0.900), and 3-year portal vein patency rates were 95.0%. There were no significant differences observed in combination therapy-related adverse events (p = 0.253) and perioperative complications (p = 0.613) between the Vp3 and Vp4 groups. The recurrence patterns were similar between the two groups (p = 0.131). There were no significant differences in overall survival (OS) and recurrence-free (RFS) survival between the Vp3 and Vp4 groups (OS p = 0.457, RFS p = 0.985). Patients who achieved a pathological complete response had significantly better RFS (p = 0.011). Conclusion Salvage surgery after combination therapy demonstrated favorable efficacy and safety. The novel surgical approach for PVTT can effectively achieve complete removal of PVTT and ensured long-term portal vein patency. |
| first_indexed | 2024-03-08T19:49:01Z |
| format | Article |
| id | doaj.art-10e0e7246792444a89adf94b4a51db2e |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-03-08T19:49:01Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-10e0e7246792444a89adf94b4a51db2e2023-12-24T12:08:45ZengBMCBMC Surgery1471-24822023-12-0123111210.1186/s12893-023-02291-1Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitorsTianyu Jiao0Haowen Tang1Wenwen Zhang2Bingyang Hu3Tao Wan4Yinbiao Cao5Ze Zhang6Yafei Wang7Junning Cao8Mengqiu Cui9Shichun Lu10Medical School of Chinese PLAFaculty of Hepato-Pancreato-Biliary Surgery, the First Medical Centre, Chinese PLA General HospitalFaculty of Hepato-Pancreato-Biliary Surgery, the First Medical Centre, Chinese PLA General HospitalInstitute of Hepatobiliary Surgery of Chinese PLAInstitute of Hepatobiliary Surgery of Chinese PLAMedical School of Chinese PLAMedical School of Chinese PLANankai University School of MedicineOrgan Transplantation Center, The Affiliated Hospital of Qingdao UniversityMedical School of Chinese PLAFaculty of Hepato-Pancreato-Biliary Surgery, the First Medical Centre, Chinese PLA General HospitalAbstract Background It is controversial whether patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) should undergo salvage surgery following the combination therapy of tyrosine kinase inhibitors (TKIs) and programmed cell death protein 1 (PD-1) inhibitors. This study aimed to elucidate the efficiency and safety of salvage surgery following combination therapy, while also summarizing a novel surgical approach for Vp3/4 PVTT. Methods Between April 2019 and December 2022, a consecutive series of unresectable HCC patients with PVTT who received salvage surgery following combination therapy were enrolled. Evaluation included perioperative and long-term follow-up outcomes. The complete removal of Vp3/4 PVTT was achieved using a novel surgical approach characterized by “longitudinal incision and transverse suturing” and “angle-to-straight conversion”. Results Forty patients including 22 patients with Vp3 and 18 patients with Vp4 were included. Long-term follow-up showed similar rates of portal vein patency (Vp3: 95.5%, Vp4:94.4%, p = 0.900), and 3-year portal vein patency rates were 95.0%. There were no significant differences observed in combination therapy-related adverse events (p = 0.253) and perioperative complications (p = 0.613) between the Vp3 and Vp4 groups. The recurrence patterns were similar between the two groups (p = 0.131). There were no significant differences in overall survival (OS) and recurrence-free (RFS) survival between the Vp3 and Vp4 groups (OS p = 0.457, RFS p = 0.985). Patients who achieved a pathological complete response had significantly better RFS (p = 0.011). Conclusion Salvage surgery after combination therapy demonstrated favorable efficacy and safety. The novel surgical approach for PVTT can effectively achieve complete removal of PVTT and ensured long-term portal vein patency.https://doi.org/10.1186/s12893-023-02291-1Hepatocellular carcinomaPortal vein tumor thrombusSalvage surgeryProgrammed cell death protein 1 inhibitorsTyrosine kinase inhibitors |
| spellingShingle | Tianyu Jiao Haowen Tang Wenwen Zhang Bingyang Hu Tao Wan Yinbiao Cao Ze Zhang Yafei Wang Junning Cao Mengqiu Cui Shichun Lu Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitors BMC Surgery Hepatocellular carcinoma Portal vein tumor thrombus Salvage surgery Programmed cell death protein 1 inhibitors Tyrosine kinase inhibitors |
| title | Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitors |
| title_full | Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitors |
| title_fullStr | Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitors |
| title_full_unstemmed | Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitors |
| title_short | Long-term survival and portal vein patency with novel PVTT surgery approach in advanced HCC patients with Vp3/4 PVTT following combination therapy of TKIs and PD-1 inhibitors |
| title_sort | long term survival and portal vein patency with novel pvtt surgery approach in advanced hcc patients with vp3 4 pvtt following combination therapy of tkis and pd 1 inhibitors |
| topic | Hepatocellular carcinoma Portal vein tumor thrombus Salvage surgery Programmed cell death protein 1 inhibitors Tyrosine kinase inhibitors |
| url | https://doi.org/10.1186/s12893-023-02291-1 |
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