Is Macroscopic Portal Vein Tumor Thrombosis of HCC Really an Exclusion for Liver Transplantation?
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REVIEW ARTICLE
Is Macroscopic Portal Vein Tumor Thrombosis of HCC Really an Exclusion for Liver Transplantation? Cemalettin Aydin 1
&
Sezai Yilmaz 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Hepatocellular carcinoma is a heterogenous group of disease with a spectrum of disease presentations that developed on the setting of liver cirrhosis, although the achievements made in the imaging techniques have enabled the early diagnosis in nearly 60% of the cases in cirrhotic patients. However, hepatobiliary centers and tertiary liver transplant centers have to treat patients with advanced hepatocellular carcinoma with portal venous tumor thrombosis. Methods In this review, liver transplantation results in hepatocellular carcinoma patients with portal vein tumor thrombosis is reviewed. Results Although historically portal venous tumor thrombosis is considered a contraindication for radical surgical procedures such as liver transplantation, current data suggests that patients with hepatocellular carcinoma and macrovascular invasion can achieve favorable outcomes with liver transplantation provided that strict selection criteria is applied. One of the cornerstones of treatment of these patients is development of locoregional therapy such as transarterial chemo and radioembolizations. Transarterial radioembolization is effective in patients if the pretreatment liver failure is mild and the tumor burden including extension to the portal vein is low. Although data is lacking especially radioembolization could even help physicians to differentiate tumors with favorable biologic characteristics. Conclusions Therefore, these patients should be subject of multimodality treatment, and liver transplantation should be offered whenever objective and significant response is obtained by locoregional therapies. Keywords Advanced hepatocellular carcinoma . Downstaging . Transarterial radioembolization . Transarterial chemoembolization . Liver transplantation
Abbreviations AFP Alpha-feto-protein HCC Hepatocellular carcinoma LDLT Living donor liver transplantation LT Liver transplantation PIVKA-II Protein induced by vitamin k absence/antagonist-II PVTT Portal vein tumor thrombosis SBRT Stereotactic body radiotherapy TACE Transarterial chemoembolization TARE Transarterial radioembolization
* Sezai Yilmaz [email protected] 1
Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 44280 Malatya, Turkey
Introduction Portal vein tumor thrombosis (PVTT) occurs in about 35– 50% of patients with hepatocellular carcinoma (HCC) and involves the main trunk in 15–30% of cases at the time of diagnosis. The prognosis of patients with locally advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains dismal. The presence of PVTT is considered a strong negative prognostic factor, due to the increased risk of spillage of cancer cells into the bloodstream, leading to a high recurrence risk. The median survival has b
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