Comprehensive review of hepatocellular carcinoma with portal vein tumor thrombus: State of art and future perspectives
Paschalis Gavriilidis a , ∗, Timothy M Pawlik b , Daniel Azoulay c
a Department of Surgery, Colchester General Hospital, Turner Road, Colchester CO4 5JL, UK
b Department of Surgery, The Ohio State Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
c Department of Hepato-Biliary and Liver Transplantation surgery, Paul Brousse University Hospital, Paris-Saclay University, Villejuif 94800, France
Abstract：Background: Despite advances in the diagnosis of patients with hepatocellular carcinoma (HCC), 70%-80% of patients are diagnosed with advanced stage disease. Portal vein tumor thrombus (PVTT) is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated.
Data sources: A systematic search of MEDLINE (PubMed), Embase, Cochrane Library and Database for Systematic Reviews (CDSR), Google Scholar, and National Institute for Health and Clinical Excellence (NICE) databases until December 2022 was conducted using free text and MeSH terms: hepatocellular carcinoma, portal vein tumor thrombus, portal vein thrombosis, vascular invasion, liver and/or hepatic resection, liver transplantation, and systematic review.
Results: Centers of surgical excellence have reported promising results related to the individualized surgi- cal management of portal thrombus versus arterial chemoembolization or systemic chemotherapy. Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus, accurate identification of the subgroups of patients who may benefit from resection, as well as meticulous surgical technique. This review addressed five specific areas: (a) formation of PVTT; (b) classifications of PVTT; (c) controversies related to clinical guidelines; (d) surgical treatments versus non-surgical approaches; and (e) characterization of surgical techniques correlated with classifications of PVTT.
Conclusions: Current evidence from Chinese and Japanese high-volume centers demonstrated that pa- tients with HCC and associated PVTT can be managed with surgical resection with acceptable results.
2024, Vol. 23 
