Inspiration of liver resection for hepatocellular carcinoma associated with hepatic vein invasion, not inferior vena cava invasion

The treatment for advanced hepatocellular carcinoma (HCC) has been limited to transarterial chemoembolization (TACE) or medical therapy as a palliative treatment. Patients with HCC that grossly invades the portal or hepatic vein have a limited life span. Thus, the current Barcelona Clinic for Liver Cancer (BCLC) staging system recommends systemic therapy with sorafenib (1). However, several papers (2-5) have reported their results of TACE, hepatic resection, or transplantation in patients with macroscopic vascular invasion (MVI), especially portal vein tumor thrombus (PVTT). The treatment for HCC with MVI is still under debate.