Hepatocellular carcinoma (HCC) is a malignant tumor common worldwide, ranking sixth in incidence rate and third in cancer-related mortality, with more than 800000 new cases every year [1], which seriously affects the life and health of people around the world. Treatment options for HCC include hepatectomy, ablation, liver transplantation, radiotherapy, systemic therapy, and so on. Among them, hepatectomy is the preferred approach and the most important potentially curative therapy for HCC [2]. However, there is a big controversy over the feasibility of hepatectomy for HCC with conditions like major vascular invasion, limited and resectable multifocal disease, etc. [3].

Due to the unique anatomical structure of the liver and the oncological characteristics of HCC, vascular invasion is common in the disease. When the portal vein is invaded, portal vein tumor thrombosis (PVTT) is often seen, with an incidence rate ranging from 44 % to 62.2 % [4]. Initially, surgery for PVTT was intended as an emergency measure to treat imminent rupture and bleeding of esophagogastric varices. However, some Japanese surgeons later observed unexpectedly high survival rates (52.2 % at 1 year, 23.2 % at 2 years, and 11.6 % at 3 years) in some patients who had undergone tumor thrombectomy combined with hepatectomy for HCC with PVTT, although the aim of the surgery was to prevent rupture of esophagogastric varices by portal decompression [5]. In the West, represented by Europe and the United States, PVTT is generally considered a possible contraindication to hepatectomy and, with the advancement of medicine, systemic therapy is recommended as the first-line treatment [6]. Different perspectives are held in the East, represented by China and Japan [[7], [8], [9], [10]], where hepatectomy is still the treatment of first choice for PVTT of Cheng's classification I and II. As to PVTT of Cheng's classification III, treatment options such as hepatectomy, transarterial chemoembolization (TACE) and targeted therapy can be selected based on individual circumstances. Systemic treatment is recommended for PVTT of Cheng's classification IV. In China, a considerable number of HCC patients with PVTT underwent hepatectomy in the past.

Currently, there is no consensus on the standard treatment for HCC with PVTT. In line with the Eastern perspectives, our center has performed a substantial number of hepatectomies for HCC with PVTT over the past years. This study used our center's patient data to investigate the influence of PVTT on hepatectomy.