{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T20:48:34Z","timestamp":1779310114350,"version":"3.51.4"},"reference-count":43,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hepatocellular carcinoma (HCC) is the sixth most frequent diagnosed tumor worldwide and the third leading cause of cancer related death. According to the EASL Guidelines, HCC with portal vein tumor thrombosis (PVTT) is classified as an advanced stage (BCLC stage C) and the only curative option is represented by systemic therapy. Therefore, treatment of HCC patients with PVTT remains controversial and debated. In this paper, we describe the case of a 66-year-old man with a recurrent HCC with PVTT who underwent surgical resection. A systematic review of the literature, comparing surgical resection with other choices of treatment in HCC patients with PVTT, is reported. Methods: A systematic review of the literature regarding all prospective and retrospective studies comparing the survival outcomes of HCC patients with PVTT treated with surgical resections (SRs) or other non-surgical treatments (n-SRs) has been conducted. Case presentation: A 66-year-old Caucasian man with a history of Hepatitis C Virus (HCV) related liver cirrhosis and previous hepatocellular carcinoma of the VI segment treated with percutaneous ethanol infusion (PEI) seven years before presented to our clinics. A new nodular hypoechoic lesion in the VI hepatic segment was demonstrated on follow-up ultrasound examination. A hepatospecific magnetic resonance imaging (MRI) scan confirmed also the presence of a 18 \u00d7 13 mm nodular lesion in the V hepatic segment with satellite micronodules associated with V\u2013VIII sectoral portal branch thrombosis. The case was then discussed at the multidisciplinary team meeting, and it was decided to perform a right hepatectomy. The postoperative course was regular and uneventful, and the discharge occurred seven days after the surgery. At eight-month follow-up, there was no clinical nor radiological evidence of neoplastic recurrence, with well-preserved liver function (Child-Pugh A5). Results: Nine studies were included in the review. Median Overall Survaival (OS) ranged from 8.2 to 30 months for SRs patients and from 7 to 13.3 for n-SRs patients. In SR patients, one-year survival ranged from 22.7% to 100%, two-year survival from 9.8% to 100%, and three-year survival from 0% to 71%. In n-SRs patients, one-year survival ranged from 11.8% to 77.6%, two-year survival from 0% to 47.8%, and three-year survival from 0% to 20.9%. Conclusion: The present systematic literature review and the case presented demonstrated the efficacy of surgery as a first-line treatment in well-selected HCC patients with PVTT limited or more distal to the right and left portal branches. However, further studies, particularly randomized trials, need to be conducted in future to better define the surgical indications.<\/jats:p>","DOI":"10.3390\/jcm11185287","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T01:40:13Z","timestamp":1662601213000},"page":"5287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Surgical Resection of a Recurrent Hepatocellular Carcinoma with Portal Vein Thrombosis: Is It a Good Treatment Option? A Case Report and Systematic Review of the Literature"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9793-3250","authenticated-orcid":false,"given":"Giuseppe","family":"Sena","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Paglione","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1066-4671","authenticated-orcid":false,"given":"Gaetano","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Goglia","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sant\u2019Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariasara","family":"Osso","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Nardo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3322\/caac.20107","article-title":"Liver Cancer Estimated Incidence, Mortality and Prevalence Worldwide in 2012. Global Cancer Statistics","volume":"61","author":"Jemal","year":"2011","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1634\/theoncologist.2010-S4-05","article-title":"The Incidence and Epidemiology of Hepatocellular Carcinoma: A Global and Regional Perspective","volume":"15","author":"Venook","year":"2010","journal-title":"Oncologist"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ijsu.2015.05.009","article-title":"The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus","volume":"20","author":"Zhang","year":"2015","journal-title":"Int. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1177\/000313480907501116","article-title":"Aggressive Resection of Hepatocellular Carcinoma with Right Atrial Involvement","volume":"75","author":"Florman","year":"2009","journal-title":"Am. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jamcollsurg.2008.02.017","article-title":"Caval Invasion by Liver Tumor Is Limited","volume":"207","author":"Hashimoto","year":"2008","journal-title":"J. Am. Coll. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s00595-013-0585-6","article-title":"Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus","volume":"44","author":"Katagiri","year":"2013","journal-title":"Surg. Today"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","article-title":"BCLC strategy for prognosis prediction and treatment recommendation Barcelona Clinic Liver Cancer (BCLC) staging system: The 2022 update","volume":"76","author":"Reig","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1002\/hep.31187","article-title":"Treatment of Hepatocellular Carcinoma in the Precision Medicine Era: From Treatment Stage Migration to Therapeutic Hierarchy","volume":"72","author":"Vitale","year":"2020","journal-title":"Hepatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s12072-010-9165-7","article-title":"Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma","volume":"4","author":"Omata","year":"2010","journal-title":"Hepatol. Int."},{"key":"ref_10","first-page":"1","article-title":"Primary Liver Cancer Diagnosis and Treatment Expert Panel of the Chinese Ministry of Health. Guidelines on the diagnosis and treatment of primary liver cancer (2011 edition)","volume":"1","author":"Qin","year":"2012","journal-title":"Chin. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_12","first-page":"223","article-title":"The CARE guidelines: Consensus-based clinical case reporting guideline development","volume":"7","author":"Gagnier","year":"2013","journal-title":"BMJ Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s00534-010-0314-0","article-title":"A new classification for hepatocellular carcinoma with portal vein tumor thrombus","volume":"18","author":"Shi","year":"2010","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.ijsu.2017.06.082","article-title":"Hepatectomy after down-staging of hepatocellular carcinoma with portal vein tumor thrombus using chemoradiotherapy: A retrospective cohort study","volume":"44","author":"Hamaoka","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1002\/jso.26282","article-title":"Surgical management of hepatocellular carcinoma patients with portal vein thrombosis: The United States Safety Net and Academic Center Collaborative Analysis","volume":"123","author":"Ryon","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4725","DOI":"10.1002\/cncr.26561","article-title":"Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus","volume":"118","author":"Peng","year":"2012","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e3959","DOI":"10.1097\/MD.0000000000003959","article-title":"Hepatic resection or transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus","volume":"95","author":"Zheng","year":"2016","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.jhep.2016.05.044","article-title":"Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion","volume":"65","author":"Kokudo","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1007\/s00268-013-1969-x","article-title":"Surgical Resection Versus Conformal Radiotherapy Combined with TACE for Resectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Comparative Study","volume":"37","author":"Tang","year":"2013","journal-title":"World J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.3748\/wjg.v11.i8.1215","article-title":"Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis","volume":"28","author":"Fan","year":"2005","journal-title":"World J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"17141","DOI":"10.3748\/wjg.v20.i45.17141","article-title":"Appropriate treatment strategies improve survival of hepatocellular carcinoma patients with portal vein tumor thrombus","volume":"20","author":"Ye","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/jjco\/hyv089","article-title":"Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus","volume":"45","author":"Zhang","year":"2015","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1053\/j.gastro.2006.05.021","article-title":"Prospective Cohort Study of Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma in 8510 Patients","volume":"131","author":"Takayasu","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1245\/s10434-010-1321-8","article-title":"Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Prospective Comparative Study","volume":"18","author":"Luo","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/j.1440-1746.2008.05728.x","article-title":"Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion","volume":"24","author":"Kim","year":"2009","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1002\/(SICI)1097-0142(19970601)79:11<2087::AID-CNCR5>3.0.CO;2-M","article-title":"The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study","volume":"79","author":"Lee","year":"1997","journal-title":"Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1056\/NEJMoa1915745","article-title":"Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma","volume":"382","author":"Finn","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1056\/NEJMoa0708857","article-title":"Sorafenib in advanced hepatocellular carcinoma","volume":"359","author":"Llovet","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1245\/s10434-010-0940-4","article-title":"Surgical Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus","volume":"17","author":"Shi","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_31","first-page":"1421","article-title":"Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein","volume":"48","author":"Konishi","year":"2001","journal-title":"Hepato Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.surg.2004.12.012","article-title":"Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: Results of a multicenter study","volume":"137","author":"Pawlik","year":"2005","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1007\/s11605-009-0854-2","article-title":"Surgical Strategy for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Based on Prognostic Factors","volume":"13","author":"Kondo","year":"2009","journal-title":"J. Gastrointest. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.jamcollsurg.2005.11.012","article-title":"Prognostic Index for Patients with Hepatocellular Carcinoma Combined with Tumor Thrombosis in the Major Portal Vein","volume":"202","author":"Ikai","year":"2006","journal-title":"J. Am. Coll. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.gassur.2005.12.011","article-title":"Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series","volume":"10","author":"Hardwigsen","year":"2006","journal-title":"J. Gastrointest. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/1471-230X-13-60","article-title":"Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: A meta-analysis","volume":"13","author":"Xue","year":"2013","journal-title":"BMC Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1007\/s00268-013-2290-4","article-title":"Surgical Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombosis","volume":"38","author":"Chok","year":"2013","journal-title":"World J. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Shaohua, L., Qiaoxuan, W., Peng, S., Qing, L., Zhongyuan, Y., Ming, S., Wei, W., and Rongping, G. (2015). Surgical Strategy for Hepatocellular Carcinoma Patients with Portal\/Hepatic Vein Tumor Thrombosis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0130021"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1001\/archsurg.135.11.1273","article-title":"An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation","volume":"135","author":"Wu","year":"2000","journal-title":"Arch. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.amjsurg.2008.09.026","article-title":"Adjuvant transcatheter arterial chemoembolization improves efficacy of hepatectomy for patients with hepatocellular carcinoma and portal vein tumor thrombus","volume":"198","author":"Peng","year":"2009","journal-title":"Am. J. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1007\/s00268-006-0271-6","article-title":"Efficacy of postoperative transarterial chemoembolization and portal vein chemotherapy for patients with hepatocellular carcinoma complicated by portal vein tumor thrombosis-a randomized study","volume":"30","author":"Li","year":"2006","journal-title":"World J. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"752135","DOI":"10.3389\/fsurg.2021.752135","article-title":"One-Stage Total Laparoscopic Treatment for Colorectal Cancer with Synchronous Metastasis. Is It Safe and Feasible?","volume":"8","author":"Sena","year":"2021","journal-title":"Front. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"40816","DOI":"10.18632\/oncotarget.8386","article-title":"Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus\u2014Eastern Hepatobiliary Surgical Hospital consensus statement","volume":"7","author":"Cheng","year":"2016","journal-title":"Oncotarget"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/18\/5287\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:25:22Z","timestamp":1760142322000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/18\/5287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,7]]},"references-count":43,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcm11185287"],"URL":"https:\/\/doi.org\/10.3390\/jcm11185287","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,7]]}}}