{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:14:16Z","timestamp":1790810056541,"version":"4.1.0"},"reference-count":38,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT) has a poor prognosis, and the benefits of neoadjuvant therapy are unclear. This systematic review and meta-analysis aim to evaluate the impact of neoadjuvant treatment (NAT) followed by surgery versus surgery alone on survival outcomes. Methods: A PRISMA-compliant systematic review was conducted by searching the OVID databases Embase, Medline, PubMed, and Scopus for English-language comparative studies of resectable HCC with PVTT, up to 23 January 2025. Two reviewers independently screened, extracted data, and assessed risk of bias (ROBINS-I\/ROB2). Hazard ratios (HRs) for overall survival (OS) and recurrence-free survival (RFS) were pooled for meta-analysis. Results: Seven studies (2015\u20132024, five retrospective cohorts, one non-randomised comparative, one RCT) included 621 patients. The pooled analysis demonstrated that NAT followed by surgery was associated with a significantly improved OS (HR: 0.48, 95% CI: 0.295\u20130.67, p-value &lt; 0.001, I2 = 0.00) and improved RFS (HR: 0.4, 95% CI: 0.2\u20130.58, p-value &lt; 0.001, I2 = 0.00). Conclusions: For patients with HCC and an associated PVTT, neoadjuvant treatment before surgery significantly improves both overall and recurrence-free survival. These findings support a multimodal approach. Current evidence is largely non-randomised and HBV-endemic, warranting prospective validation in aetiologically diverse cohorts, including Western ones.<\/jats:p>","DOI":"10.3390\/cancers18020277","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T09:28:12Z","timestamp":1768555692000},"page":"277","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impacts of Liver Resection with Neoadjuvant Treatment Versus Surgery Alone in Hepatocellular Carcinoma with Portal Vein Tumour Thrombosis: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6550-9137","authenticated-orcid":false,"given":"Poyyamozhi","family":"Rajagopal","sequence":"first","affiliation":[{"name":"Department of HPB Surgery, Hammersmith Hospital, Imperial College Health Care NHS Trust, London W12 0HS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesav Aditya","family":"Vijayagopal","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery, Hammersmith Hospital, Imperial College Health Care NHS Trust, London W12 0HS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7404-1587","authenticated-orcid":false,"given":"Shanmuga S.","family":"Kannan","sequence":"additional","affiliation":[{"name":"Department of UGI Surgery, Luton & Dunstable University Hospital, Luton LU4 0DZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shraddha","family":"Shetty","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery, Hammersmith Hospital, Imperial College Health Care NHS Trust, London W12 0HS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhava","family":"Pai","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery, Hammersmith Hospital, Imperial College Health Care NHS Trust, London W12 0HS, UK"},{"name":"Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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