Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: is it time to reconsider the current treatment guidelines?

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is responsible for 70–90% of cases (1,2). The presence of macrovascular invasion such as portal vein tumor thrombus (PVTT) or hepatic vein tumor thrombus (HVTT) is known to be significantly associated with poor prognosis (3). The Barcelona clinic liver cancer (BCLC) staging system has been adopted and approved for guidance for HCC management by both the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Disease (AASLD) (4,5). According to this treatment guideline, HCC patients with macrovascular invasion are regarded as being at the advanced stage, and for whom the only proposed treatment option is sorafenib. However, the management of HCC with macrovascular invasion is complicated and still controversial.