Surgical management in hepatocellular carcinoma with portal vein tumour thrombosis: is this the end of the road or a chance to expand the criteria for resectability?

Abstract

Portal vein thrombosis is a common complication associated with malignancies such as hepatocellular carcinoma, with a dismal and negative impact on prognosis. A thorough literature search in Pubmed and Google Scholar, under the terms 'hepatocellular carcinoma AND portal vein thrombosis', regarding the surgical management of portal vein thrombosis was conducted by the authors, and the associated results are presented in this narrative review. Precise classification of portal vein thrombosis and identification of subgroups of patients that will benefit from surgery is of paramount importance. Evolution of novel surgical techniques in liver resection and associated low morbidity and mortality rates in specialized hepatobiliary centres worldwide have been linked with promising results from the adoption of surgical management in these patients, when compared to systemic chemotherapy or arterial chemoembolization management that has traditionally been followed in such cases.

Portal vein thrombosis in patients with hepatocellular carcinoma and early cirrhosis – prevalence and risk factors

“…Traditionally, direct invasion of the venous wall with HCC is a well-known mechanism for PVT but in reality, it is much more complex and tumour microenvironment in the background of cirrhosis plays a major role [ 23 ]. Tumour cells have specific properties that enhance the prothrombotic state.…”

“…Incidental finding of PVT in HCC patients with relatively preserved liver function (Child–Pugh class-A) significantly impacts their overall management and prognosis. PVT in HCC has a major impact on treatment decision, whether to go for aggressive curative intend treatment or limit oneself to palliation only [ 23 ]. BCLC staging system is widely used for categorising HCC patients depending upon tumour burden (size and the number of lesions), patient’s ECOG status, overall hepatic functions and presence and absence of vascular invasion including PVT.…”

“…BCLC staging system is widely used for categorising HCC patients depending upon tumour burden (size and the number of lesions), patient’s ECOG status, overall hepatic functions and presence and absence of vascular invasion including PVT. Liver cancer study group in Japan proposed a specific classification system for PVT in HCC, this helps further to tailor a specific management plan for each patient [ 23 ].…”