Hepatocellular Carcinoma with Hepatic Vein and Inferior Vena Cava Invasion

Hepatocellular carcinoma (HCC) invades intrahepatic vessels causing tumor thrombosis. Infrequently, there is involvement of the hepatic vein (HV) and inferior vena cava (IVC). In this review, we summarize epidemiology, classification, clinical features, management HCC with HV IVC invasion. While usually portends an overall poor survival, selected patients may be candidates for aggressive treatment thus improving outcomes. Lay summary/ key points•Hepatocellular cancer infrequently involves and/or results into thrombosis.•Such traditionally considered to indicate outcomes only systemic therapy recommended.•Selective such thrombosis benefit from including surgery radiotherapy or a combination varied treatments. •Hepatocellular sixth most common fourth highest mortality globally.1https://gco.iarc.fr/today/fact-sheets-cancers: accessed 5 june 2022.Google Scholar,2Galle P. Forner A. Llovet J. et al.EASL practice guidelines: hepatocellular carcinoma.J Hepatol. 2018; 69: 182-236Abstract Full Text PDF PubMed Scopus (4510) Google Scholar has tendency involve within liver major adverse prognostic factor, limited options.2Galle Tumor veins (HVs) (IVC) less frequent than portal contiguous thrombus extend via right atrium (RA). There paucity literature on (HVTT IVCTT) no unequivocal agreement optimal patients. As per widely accepted Barcelona Clinic Liver Cancer (BCLC) staging, these tumors are as advanced qualify very short survival. However, lead better outcome. Here review autopsy series, HVTT was seen in 54 (23%) HCC. Of these, 12 were protruding 11 reached RA. The series also made record one patient thrombi both pulmonary arteries.3Nakashima T. Okuda K. Kojiro M. al.Pathology Japan: 232 consecutive cases autopsied ten years.Cancer. 1983; 51: 863-877Crossref (559) Ninety percent HVs had veins. Japanese national registry, 5% invasion imaging (862/17263).4Kudo Izumi N. 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It post-transplant setting.2Galle Scholar,41Kokudo Scholar,42Andreou Bahra Schmelzle al.Predictive transplantation.Clin Transplant. 30: 819-827Crossref Scholar•Surgical viable option appropriately Intraoperative ultrasonography estimate TT well detect occult lesions advocated.27Zhang Scholar,43Letreut Hardwigsen Ananian vasculature. A case-control series.J Gastrointest 10: 855-862Crossref (19) Transsection carried out continuous intermittent clamping pedicle (Pringle maneuver).43Letreut Mobilization dissection performed Le Treur al., except large approached anteriorly.27Zhang For HVTT, exclusion (HVE) if necessary briefly possible,27Zhang anatomic wherever possible.29Ikai can either en bloc extracted according extent.27Zhang IVCTT, removed under total HVE veno-venous bypass.27Zhang Scholar,29Ikai extending RA, cardiopulmonary bypass.29Ikai retrospective treated 1985 2001 analyzed.29Ikai year vv0, vv1, vv2, 43%, 19%, 11%, 0%, Patients trunk survived significantly longer those (P 0.008). No significant among HVs. 5-year who underwent palliative (6% vs 8%). years; early lung Jiang al.22Jiang showed determinant OS (RFS). did report separately. 3-year RFS V3 plus V4 56.9% 25.0%, respectively; V1 V2 90.2% 51.0%, respectively.22Jiang Pawlik al.44Pawlik Poon Abdalla al.Hepatectomy multicenter study.Surgery. 137: 403-410Abstract (199) 1-, 3-, rates 45%, 17%, 10%, respectively, undergoing resection. multivariate analysis, moderate severe fibrosis parenchyma predictor short-term long-term mortality.44Pawlik Roayaie al.39Roayaie 4.7 months (±2.1 m) ICVTT.