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Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: Surgical Outcomes and the Prognostic Impact of Concomitant Major Vascular Invasion

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Abstract

Background

The aim of this study was to clarify the long-term surgical outcomes of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) and to identify a therapeutic strategy for this condition.

Methods

Forty-four patients who underwent hepatectomy for HCC with BDTT or direct invasion involving the first branches of the bile duct or common hepatic duct were enrolled in this study. The overall survival time and time to recurrence were analyzed.

Results

The median survival time and the 5-year survival rate were 23.7 months and 31.0 %, respectively. Child-Pugh classification B [hazard ratio (HR) 4.92; 95 % confidence interval (CI) 1.97–11.65], major vascular invasion (MVI; HR 2.79; 95 % CI 1.14–6.87), and serosal invasion (HR 2.71; 95 % CI 1.19–6.02) were independent prognostic factors for overall survival. The median survival times were 12.3 and 72.3 months for the patients with and without MVI, respectively. Among the 41 patients who underwent macroscopic curative resection, the median time to recurrence and the 5-year recurrence rate were 8.6 months and 85.6 %, respectively. MVI was the only independent prognostic factor for recurrence (HR 3.31; 95 % CI 1.55–7.05). The median times to recurrence were 3.7 and 11.6 months for the patients with and without MVI, respectively.

Conclusions

Concomitant MVI was a strong prognostic factor in the setting of HCC with BDTT. Extended hepatectomy provided a good prognosis for the patients with BDTT alone without MVI.

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Abbreviations

BDR:

Common bile duct resection

BDTT:

Bile duct tumor thrombus

CI:

Confidence interval

EBD:

Endoscopic biliary drainage

HAI:

Hepatic arterial infusion

HCC:

Hepatocellular carcinoma

ICG:

Indocyanine green

HR:

Hazard ratio

MVI:

Major vascular invasion

mVI:

Microvascular invasion

PHLF:

Post-hepatectomy liver failure

PTBD:

Percutaneous transhepatic biliary drainage

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Conflicts of interest

All authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho Shogoin, Sakyo-ku, Kyoto, 6068507, Japan

    Yosuke Kasai, Etsuro Hatano, Satoru Seo, Kojiro Taura, Kentaro Yasuchika & Shinji Uemoto

Authors
  1. Yosuke Kasai
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  2. Etsuro Hatano
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  3. Satoru Seo
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  4. Kojiro Taura
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  5. Kentaro Yasuchika
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  6. Shinji Uemoto
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Correspondence to Etsuro Hatano.

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Kasai, Y., Hatano, E., Seo, S. et al. Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: Surgical Outcomes and the Prognostic Impact of Concomitant Major Vascular Invasion. World J Surg 39, 1485–1493 (2015). https://doi.org/10.1007/s00268-015-2985-9

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