The prognosis of advanced liver malignancy with inferior vena cava (IVC) thrombi is poor. Many therapeutic policies are challenging for long-term prognosis. We performed the modified effective technique of transdiaphragmatic intrapericardial IVC isolation for curative resection of IVC tumors and prolonged survival time. Between 2003 and 2015, 10 patients, sustained liver malignancy with IVC thrombi, underwent surgical intervention. Liver resection with thrombectomy under total hepatic vascular exclusion via the transdiaphragmatic intrapericardial IVC isolation method was performed for these 10 patients. The first 4 patients underwent retrohepatic IVC resection in order to complete resection, and the other 6 patients preserved the retrohepatic IVC. The last 3 patients received preoperative locoregional therapies, and all 10 patients received postoperative adjuvant chemotherapies immediately. All 10 patients underwent gross en bloc tumor resections with thrombectomy with R0 resection. There was no surgical mortality. Shortening of operation time and reduction of both intraoperative blood loss and hospital stay were demonstrated in the last 6 patients with preserving the retrohepatic IVC. However, similar time to recurrence and survival time were noted in the first 7 patients. The last 3 patients, who had received preoperative locoregional therapies, have better disease-free survival time. Simplified surgical procedure combined with preoperative locoregional therapies and rapid postoperative adjuvant treatment may provide a greater advantage for these patients.

Adjuvant XELOX (capecitabine plus oxaliplatin) and TS-1 (S-1) monotherapy are both guideline-recommended following D2 gastrectomy for gastric cancer, yet head-to-head real-world data exclusively in stage III disease remain scarce. Using Taiwan’s National Health Insurance Research Database linked to the Taiwan Cancer Registry–Long Form, we identified stage III gastric cancer patients who underwent D2 gastrectomy (2010–2019) and received adjuvant XELOX or TS-1 for ≥3 months. Propensity score matching balanced chemotherapy and non-chemotherapy cohorts (1706/group). Overall survival (OS) was the primary endpoint; disease progression was defined as initiation of FOLFOX salvage chemotherapy (used as a pragmatic proxy for disease recurrence). A second propensity score matching was performed directly between XELOX (n = 533) and TS-1 (n = 893) groups, yielding 490 matched pairs with well-balanced baseline characteristics. Multivariable Cox regression was adjusted for sex, age, comorbidities, and Charlson Comorbidity Index. TS-1 was associated with significantly better OS (adjusted HR 0.73, 95% CI 0.61–0.86; p < 0.001) and lower progression (adjusted HR 0.38, 95% CI 0.23–0.62; p < 0.001) versus XELOX; the corresponding 3-year OS was approximately 65.4% for TS-1 versus 56.8% for XELOX, and extrapolated 5-year OS approximately 50.2% versus 41.7%, respectively (note: these 5-year estimates are Kaplan–Meier projections beyond the mean follow-up of ~2.6 years and carry substantial uncertainty; they should be interpreted with caution). Benefits were confined to stage IIIA (OS HR 0.64, 95% CI 0.45–0.89; p = 0.009; interaction p = 0.006; progression HR 0.29, 95% CI 0.11–0.76; p = 0.011), with comparable outcomes in IIIB and IIIC. Adjuvant TS-1 monotherapy was associated with superior OS and lower disease progression versus XELOX in stage III gastric cancer, particularly in stage IIIA; these findings are hypothesis-generating and warrant confirmation in prospective randomized trials, whereas in stage IIIB/IIIC outcomes were comparable between the two regimens.