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World J Gastrointest Surg. Aug 27, 2021; 13(8): 796-805
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.796
Treatment for hepatocellular carcinoma with tumor thrombosis in the hepatic vein or inferior vena cava: A comprehensive review
Zun-Yi Zhang, Er-Lei Zhang, Bi-Xiang Zhang, Xiao-Ping Chen, Wei Zhang
Zun-Yi Zhang, Er-Lei Zhang, Bi-Xiang Zhang, Xiao-Ping Chen, Wei Zhang, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 434000, Hubei Province, China
Author contributions: Zhang ZY performed the majority of the writing and prepared the figures and tables; Zhang EL, Zhang BX, and Chen XP performed data and writing accusation; Zhang W designed the outline of this paper.
Supported by the National Natural Science Foundation of China, No. 81802767 and No. 81860117.
Conflict-of-interest statement: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, and there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Zhang, MD, Professor, Research Laboratory and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan 434000, Hubei Province, China. weizhangtjh@hust.edu.cn
Received: February 10, 2021
Peer-review started: February 10, 2021
First decision: March 30, 2021
Revised: April 12, 2021
Accepted: July 2, 2021
Article in press: July 2, 2021
Published online: August 27, 2021
Abstract

Hepatocellular carcinoma (HCC) is the most common type of liver cancer with a high mortality rate worldwide. The percentage of HCC patients with vascular invasion is high. However, tumor thrombus in the hepatic vein (HVTT) has a lower incidence than tumor thrombus in the portal vein (PVTT). Conventionally, HCC patients with HVTT are treated the same as HCC patients with PVTT and offered sorafenib or other systemic agents. However, according to recent studies, it is evident that HCC with HVTT shows different outcomes when classified into different subgroups. In this review, we discuss the recent progress and changes in treatment of HCC with HVTT.

Keywords: Hepatocellular carcinoma, Vascular invasion, Surgery, Transarterial chemoembolization

Core Tip: Vascular invasion or tumor thrombus in hepatocellular carcinoma (HCC) patients is very common. Vascular invasion includes two different types, i.e., tumor thrombosis in the portal vein (PVTT) or hepatic vein (HVTT). Compared with PVTT, HVTT is found with a lower incidence. Most of published studies are concentrated on HCC with PVTT. Recent studies have proved magnificent prognostic results in HCC patients with HVTT. Several classifications have been proposed to gauge the prognoses of HVTT. Although further investigations are needed, expanding treatment options including hepatectomy, radiotherapy, radioembolization, and systemic treatment are reported to improve the outcomes of patients with HVTT.