Eastern experience: surgical resection may be the first choice of treatment for selected hepatocellular carcinoma patients with portal vein tumor thrombus

Hepatocellular carcinoma (HCC) is the sixth most common worldwide cancer and has dismal outcomes because of its high morbidity and mortality, particularly in Eastern countries (1,2); however, the morbidity of HCC is increasing in the Western counties (3). Portal vein tumor thrombosis (PVTT) occurs in 44–62.2% of patients with advanced HCC a with a natural median survival time (MST) of 2.7–4 months and is the most commonly recognized risk factor for prognosis (4). PVTT is regarded as an advanced stage of HCC, and sorafenib is only recommended to treat PVTT according to the American Association for the Study of the Liver Disease/Barcelona Clinic Liver Cancer (AASLD/BCLC) staging system and treatment guidelines (5-7). Despite recent advances in the treatment of such patients, the treatment strategies for PVTT remain controversial.