We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

An Appraisal of Liver and Portal Vein Resection for Hepatocellular Carcinoma With Tumor Thrombi Extending to Portal Bifurcation—Invited Critique

Ronald P. DeMatteo, MD
Arch Surg. 2000;135(11):1279. doi:10.1001/archsurg.135.11.1279.
Text Size: A A A
Published online


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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles