Experimental study on surgery of portal tumor thrombus of hepatocellular carcinoma. tumor cell-endothellal cell adhesion and uptake of thrombolytic agents in thrombus.

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Hepatocellular carcinoma with tumor thrombus in the portal vein trunk is of imminently poor prognosis and has been considered out of surgical indication. Recently we have advocated removal of such tumor thrombi with successful evidences. However, there are two problems involved in practice: intrahepatic tumor celldissemination and portal vein thrombosis after the operation. We performed in vitro assay tumor cell-adhesion to the endothelial cell of hepatic sinusoid assay and experimental evaluation of intraportal administration of fibrinolytic agents.Heparin depressed the number of tumor cell adhesion to endothelial cells by 45%, while anticancer agents such as Adriamycin, MMC and 5FU increased the number by 150-400%. The perportal fibrinolytic therapy with urokinase of tissue plasminogen activator was effetive so much as in the pelvic vein. Mild liver dysfunction was induced by intrapotal urodinase injection.These results suggest that anti thrombotic agent is preferable for the prevention of tumor cell dissemination and anticancer agen t has reverse effect probably by endothelial injury and that fibrinolytic therapy is useful for the postoperative portal thrombosis. but further investigation should be done about the hepatic side effect etc.