Hepatocellular carcinoma with obstructive jaundice: Biliary drainage and multimodal therapy

Table 3 Potential treatment approaches after biliary drainage in hepatocellular carcinoma with obstructive jaundice

Disease setting	Potential approach after successful drainage	Evidence basis and limitation
Resectable disease with adequate hepatic reserve	Hepatectomy with thrombectomy and selective bile duct resection when required for complete resection	Retrospective surgical cohorts; strong selection by anatomy, hepatic reserve, and tumor stage
Unresectable, intrahepatic-predominant disease	TACE in selected patients; HAIC or focal radiotherapy only after case-specific multidisciplinary review or in trials	TACE: Retrospective HCC-OJ cohorts; HAIC/radiotherapy: Small series, case reports, or extrapolation
Advanced disease with PVTT or extrahepatic spread	Systemic therapy only after adequate hepatic recovery and infection control; clinical trial preferred	No direct prospective OJ evidence; recommendations extrapolated from broader HCC trials
Transplant consideration	Exceptionally selected, center-specific assessment; not a standard indication	Small single-center retrospective series; no validated general selection criteria
Inadequate drainage response or progressive hepatic failure	Drainage optimization, infection control, symptom palliation, best supportive care, and reassessment	Clinical-practice framework; no comparative prospective evidence

TACE: Transarterial chemoembolization; HAIC: Hepatic arterial infusion chemotherapy; HCC: Hepatocellular carcinoma; OJ: Obstructive jaundice; PVTT: Portal vein tumor thrombus.