Bile duct thrombi in hepatocellular carcinoma: is aggressive surgery worthwhile?

Rammohan, Ashwin; Sathyanesan, Jeswanth; Rajendran, Kamalakannan; Pitchaimuthu, Anbalagan; Perumal, Senthil Kumar; Balaraman, K.; Ramasamy, Ravi; Palaniappan, Ravichandran; Govindan, Manoharan

doi:10.1111/hpb.12383

Cited by 30 publications

(26 citation statements)

References 17 publications

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“…Among 154 potentially relevant papers identified by the initial search, 20 finally met the inclusion criteria in this review and are summarised in Table 1 [ 3 – 9 , 12 – 26 ]. All studies were retrospectively designed, originated from Asia (Japan, n = 8 [ 5 , 6 , 12 , 13 , 15 , 20 , 21 , 25 ]; Mainland China, n = 7 [ 7 , 8 , 14 , 16 , 17 , 19 , 26 ]; Korea, n = 2 [ 18 , 22 ]; Taiwan, n = 1 [ 9 ]; India, n = 1 [ 23 ]; Hong Kong, n = 1 [ 24 ]) and classified as level-4 evidence. The sample size of each study varied from 13 to 73 patients.…”

Section: Resultsmentioning

confidence: 99%

Surgical outcomes of hepatocellular carcinoma with biliary tumor thrombus: a systematic review

Qiao

Yu²,

et al. 2016

BMC Gastroenterol

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BackgroundHepatocellular carcinoma (HCC) with biliary tumor thrombus (BTT) is rare and its impact on postoperative prognosis remains controversial. The aim of this study was to evaluate the published evidence concerning the outcome of surgical resection of HCC with BTT.MethodsEligible studies were identified by searching PubMed and reviewed systematically. Comparisons of the clinicopathologic features and surgical outcomes for HCC patients with or without BTT were analyzed using meta-analytical techniques.ResultsTwenty retrospective studies containing 598 patients that met the selection criteria were included for review. The perioperative mortality was 2.1 % (range, 0–10 %), and the median 5-year overall survival (OS) was 24 % (range, 0–48 %) with a recurrence rate of 63.9 % (range, 42–91 %). Pooled analysis of 13 comparative studies showed that HCC patients with BTT had a higher incidence of vascular invasion (odds ratio [OR]: 4.70, 95 % CI: 2.90–7.60; P <0.001), a higher frequency of poor differentiation (OR: 2.07, 95 % CI: 1.23–3.49; P = 0.006), and a shorter 5-year OS rate (OR: 0.31, 95 % CI: 0.21–0.64; P <0.001) than those without BTT.ConclusionsAlthough HCC with BTT has more aggressive biological characteristics and is an indicator of poor prognosis, surgical resection can still provide long-term survival for some patients.

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Section: Resultsmentioning

confidence: 99%

Surgical outcomes of hepatocellular carcinoma with biliary tumor thrombus: a systematic review

Qiao

Yu²,

et al. 2016

BMC Gastroenterol

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“…Some studies found that the large lesions, capsule in ltration, poor differentiation, portal vein invasion and intrahepatic metastasis were more frequently observed in HCC patients with BDTT [5,18,19]. These differences suggested patients with BDTT had more particular in ltrative nature, which accounted for poorer prognosis than those without BDTT even after curative resection [7][8][9][18][19][20][21]. Since the bile duct and portal vein are encapsulated in the same Glissonian sheath, tumors can easily involve both of them.…”

Section: Discussionmentioning

confidence: 99%

Imaging features of hepatocellular carcinoma with bile duct tumor thrombus：a multicenter study

Huang¹,

Wu²,

Bai³

et al. 2020

Preprint

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Background: There are still difficult and challenging problems in diagnosis of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) before operation. This study aimed to analyze the imaging features of HCC with B1-B3 BDTT. Methods: The clinicopathological data and imaging findings of 30 HCC patients with B1-B3 BDTT from three high-volume institutions were retrospectively reviewed. Eighteen patients underwent computed tomography (CT) scans and twelve patients underwent magnetic resonance imaging (MRI) scans before operation, respectively. The diagnosis of HCC with BDTT was conﬁrmed by postoperative pathologic examination.Results: According to Japanese classification, 5 patients were classified as B1 BDTT, 12 B2, 13 B3, and 82 B4, respectively. The HCC lesions were detected in all patients, and the localized bile duct dilation were detected in 28 (93.3%) patients. The BDTT was observed in all B3 patients and 3 B2 patients, but it was not observed in all B1 patients on CT or MRI. The BDTT showed relatively hypoattenuation on plain CT scans and T1W images, relatively hyperattenuation signals on T2W. The BDTT showed hyperattenuation at hepatic arterial phase with washout at portal venous phase. The localized biliary dilation showed no enhancement at hepatic arterial phase and no progressively delayed enhancement at portal venous phase, but it was more obvious at portal venous phase on CT.Conclusions: The HCC lesions and the localized bile duct dilatation on CT or MRI scans are imaging features of HCC with BDTT, which might facilitate the early diagnosis for B1-B3 BDTT.

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“…A comparative analysis of HCC with BDTT versus HCC without BDTT by Rammohan et al (21) indicated that the degree of preoperative jaundice and tumor size were important factors affecting prognosis. This result was consistent with the current finding that the degree of preoperative jaundice was the main factor influencing long-term survival (p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Prognosis for patients with hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) after surgical treatment

Lin

Han

Zhou

2019

BST

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Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rarely seen in clinical practice, and its treatment strategies and prognosis are still a subject of debate. To ascertain the characteristics of and prognosis for HCC with BDTT, 49 patients with HCC with BDTT were studied out of 763 consecutive patients with HCC who underwent surgical treatment from July 2004 to May 2018. The clinical characteristics of and prognosis for those 49 patients were reviewed and analyzed retrospectively. Of the 49 patients, 25 underwent radical resection, 7 underwent thrombectomy through a choledochotomy, and 17 underwent palliative internal and external bile duct drainage. Results indicated that patients who underwent a radical resection had a better prognosis than patients in the other two groups, with a median survival of 19 months vs. 8 months and 3 months (p < 0.001). Moreover, the preoperative bilirubin level (p = 0.025), intraoperative blood loss (p = 0.006), tumor size (p = 0.005), and the presence of portal and hepatic vein tumor thrombi (p = 0.021) were significant prognostic factors associated with long-term survival for patients who underwent radical resection in this study. Radical resection should be performed with adequate preoperative preparation for patients with HCC with BDTT in whom surgery is not contraindicated.

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Bile duct thrombi in hepatocellular carcinoma: is aggressive surgery worthwhile?

Abstract: The mere presence of BDTT in HCC does not indicate an advanced or inoperable lesion. When technically feasible, a formal hepatic resection is the preferred first-line treatment option in these patients.

Cited by 30 publications

References 17 publications

Surgical outcomes of hepatocellular carcinoma with biliary tumor thrombus: a systematic review

Surgical outcomes of hepatocellular carcinoma with biliary tumor thrombus: a systematic review

Imaging features of hepatocellular carcinoma with bile duct tumor thrombus：a multicenter study

Prognosis for patients with hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) after surgical treatment

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