World Journal of Surgery

, Volume 37, Issue 2, pp 443–451

Surgical Outcomes of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Korean Multicenter Study

  • Deok-Bog Moon
  • Shin Hwang
  • Hee-Jung Wang
  • Sung-Su Yun
  • Kyung Sik Kim
  • Young-Joo Lee
  • Ki-Hun Kim
  • Yong-Keun Park
  • Weiguang Xu
  • Bong-Wan Kim
  • Dong Shik Lee
  • Dong-Hyun Lee
  • Hong-Jin Kim
  • Jin Hong Lim
  • Jin Sub Choi
  • Yo-Han Park
  • Sung-Gyu Lee
Article

DOI: 10.1007/s00268-012-1845-0

Cite this article as:
Moon, D., Hwang, S., Wang, H. et al. World J Surg (2013) 37: 443. doi:10.1007/s00268-012-1845-0

Abstract

Background

The long-term outcomes after resection for hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT) are unclear. This multicenter study was conducted to determine the prognosis of HCC patients with macroscopic BDTT who underwent resection with curative intent.

Methods

Of 4,308 patients with HCC from four Korean institutions, this single-arm retrospective study included 73 patients (1.7 %) who underwent resection for HCC with BDTT.

Results

Jaundice was also present in 34 patients (46.6 %). According to Ueda classification, BDTT was type 2 in 34 cases (46.6 %) and type 3 in 39 cases (53.4 %). Biliary decompression was performed in 33 patients (45.2 %), decreasing the median lowest bilirubin level to 1.4 mg/dL before surgery. Systematic hepatectomy was performed in 69 patients (94.5 %), and concurrent bile duct resection was performed in 31 patients (42.5 %). Surgical curability types were R0 (n = 57; 78.1 %), R1 (n = 11; 15.1 %), and R2 (n = 5; 6.8 %). Patient survival rates were 76.5 % at 1 year, 41.4 % at 3 years, 32.0 % at 5 years, and 17.0 % at 10 years. Recurrence rates were 42.9 % at 1 year, 70.6 % at 3 years, 77.3 % at 5 years, and 81.1 % at 10 years. Results of univariate survival analysis showed that maximal tumor size, bile duct resection, and surgical curability were significant risk factors for survival, and surgical curability was a significant risk factor for recurrence. Multivariate analysis did not reveal any independent risk factors.

Conclusions

Hepatocellular carcinoma patients with BDTT achieved relatively favorable long-term results after resection; therefore extensive surgery should be recommended when complete resection is anticipated.

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Deok-Bog Moon
    • 1
  • Shin Hwang
    • 1
  • Hee-Jung Wang
    • 2
  • Sung-Su Yun
    • 3
  • Kyung Sik Kim
    • 4
  • Young-Joo Lee
    • 1
  • Ki-Hun Kim
    • 1
  • Yong-Keun Park
    • 2
  • Weiguang Xu
    • 2
  • Bong-Wan Kim
    • 2
  • Dong Shik Lee
    • 3
  • Dong-Hyun Lee
    • 3
  • Hong-Jin Kim
    • 3
  • Jin Hong Lim
    • 4
  • Jin Sub Choi
    • 4
  • Yo-Han Park
    • 1
  • Sung-Gyu Lee
    • 1
  1. 1.Department of Surgery, Asan Medical CenterCollege of Medicine, University of UlsanSeoulKorea
  2. 2.Department of SurgerySchool of Medicine, Ajou UniversitySuwonKorea
  3. 3.Department of SurgeryCollege of Medicine, Yeungnam UniversityDaeguKorea
  4. 4.Department of SurgerySeverance Hospital, Yonsei University Health SystemSeoulKorea