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

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.

References

  1. 1.
    Matsueda K, Yamamoto H, Umeoka F et al (2001) Effectiveness of endoscopic biliary drainage for unresectable hepatocellular carcinoma associated with obstructive jaundice. J Gastroenterol 36:173–180PubMedCrossRefGoogle Scholar
  2. 2.
    Peng SY, Wang JW, Liu YB et al (2004) Surgical intervention for obstructive jaundice due to biliary tumor thrombus in hepatocellular carcinoma. World J Surg 28:43. doi:10.1007/s00268-003-7079-4 PubMedCrossRefGoogle Scholar
  3. 3.
    Esaki M, Shimada K, Sano T et al (2005) Surgical results for hepatocellular carcinoma with bile duct invasion: a clinicopathologic comparison between macroscopic and microscopic tumor thrombus. J Surg Oncol 90:226–232PubMedCrossRefGoogle Scholar
  4. 4.
    Ueda M, Takeuchi T, Takayasu T et al (1994) Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi. Hepatogastroenterology 41:349–354PubMedGoogle Scholar
  5. 5.
    Wang HJ, Kim JH, Kim JH et al (1999) Hepatocellular carcinoma with tumor thrombi in the bile duct. Hepatogastroenterology 46:2495–2499PubMedGoogle Scholar
  6. 6.
    Shiomi M, Kamiya J, Nagino M et al (2001) Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management. Surgery 129:692–698PubMedCrossRefGoogle Scholar
  7. 7.
    Yeh CN, Jan YY, Lee WC et al (2004) Hepatic resection for hepatocellular carcinoma with obstructive jaundice due to biliary tumor thrombi. World J Surg 28:471. doi:10.1007/s00268-004-7185-y PubMedCrossRefGoogle Scholar
  8. 8.
    Lee JW, Han JK, Kim TK et al (2002) Obstructive jaundice in hepatocellular carcinoma: response after percutaneous transhepatic biliary drainage and prognostic factors. Cardiovasc Interv Radiol 25:176–179CrossRefGoogle Scholar
  9. 9.
    Lee SG, Hwang S (2005) How I do it: assessment of hepatic functional reserve for indication of hepatic resection. J Hepatobiliary Pancreat Surg 12:38–43PubMedCrossRefGoogle Scholar
  10. 10.
    Fukuda S, Okuda K, Imamura M et al (2002) Surgical resection combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus: report of 19 cases. Surgery 131:300–310PubMedCrossRefGoogle Scholar
  11. 11.
    Chen MF, Jan YY, Jeng LB et al (1994) Obstructive jaundice secondary to ruptured hepatocellular carcinoma into the common bile duct. Cancer 73:1335–1340PubMedCrossRefGoogle Scholar
  12. 12.
    Kojiro M, Kawabata K, Kawano Y et al (1982) Hepatocellular carcinoma presenting as intrabile duct tumour growth: a clinicopathologic study of 24 cases. Cancer 49:2144–2147PubMedCrossRefGoogle Scholar
  13. 13.
    Schmelzle M, Matthaei H, Lehwald N et al (2009) Extrahepatic intraductal ectopic hepatocellular carcinoma: bile duct filling defect. Hepatobiliary Pancreat Dis Int 8:650–652PubMedGoogle Scholar
  14. 14.
    Lyu JW, Park do H, Kim HS et al (2007) Common bile duct thrombi secondary to hepatoma, with biliary invasion mimicking a choledocholithiasis (with video). Gastrointest Endosc 65:325–326PubMedCrossRefGoogle Scholar
  15. 15.
    Xiangji L, Weifeng T, Bin Y et al (2009) Surgery of hepatocellular carcinoma complicated with cancer thrombi in bile duct: efficacy for criteria for different therapy modalities. Langenbecks Arch Surg 394:1033–1039PubMedCrossRefGoogle Scholar
  16. 16.
    Liu QY, Lai DM, Liu C et al (2011) A special recurrent pattern in small hepatocellular carcinoma after treatment: bile duct tumor thrombus formation. World J Gastroenterol 17:4817–4824PubMedCrossRefGoogle Scholar
  17. 17.
    Lin CS, Jen YM, Chiu SY et al (2006) Treatment of portal vein tumor thrombosis of hepatoma patients with either stereotactic radiotherapy or three-dimensional conformal radiotherapy. Jpn J Clin Oncol 36:212–217PubMedCrossRefGoogle Scholar
  18. 18.
    Lee KW, Park JW, Park JB et al (2006) Liver transplantation for hepatocellular carcinoma with bile duct thrombi. Transplant Proc 38:2093–2094PubMedCrossRefGoogle Scholar
  19. 19.
    Hwang S, Moon DB, Lee SG (2010) Liver transplantation and conventional surgery for advanced hepatocellular carcinoma. Transpl Int 23:723–727PubMedCrossRefGoogle Scholar

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

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