The Treatment of Hepatocellular Carcinoma with Major Vascular Invasion.

Simple Summary: Hepatocellular carcinoma with vascular invasion has a poor prognosis and inconsistent treatment evidence. Studies of portal vein tumor thrombus are relatively frequent; however, limited case studies of bile duct tumor thrombus and hepatic vein tumor thrombus exist. In this review, we also focus on bile duct tumor thrombus and hepatic vein tumor thrombus and review the current published studies. Vascular invasion of hepatocellular carcinoma involves tumor plugs in the main trunk of the portal vein, bile ducts, and veins, and it indicates poor prognosis. It is often associated with portal hypertension, which requires evaluation and management. Treatment includes hepatic resection, systemic pharmacotherapy, hepatic arterial infusion chemotherapy, and radiation therapy. Recurrence rates post-hepatic resection are high, and systemic drug therapy often has limited therapeutic potential in patients with a poor hepatic reserve. Single therapies are generally inadequate, necessitating combining multiple therapies with adjuvant and systemic pharmacotherapy before and after hepatectomy. This narrative review will provide an overview of the treatment of hepatocellular carcinoma with vascular invasion. [ABSTRACT FROM AUTHOR]