Biliary tract invasion and obstruction by hepatocellular carcinoma: report of five cases

Lai, S. T.; Lam, Kwai; Lee, K. C.

doi:10.1136/pgmj.68.806.961

Cited by 18 publications

(11 citation statements)

References 15 publications

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“…The serum total bilirubin level can rise very rapidly and correlates well with ALP and GGT levels. Similar trends could be seen in a previous report 18 . At least four patients showed negative results on either HBV or HCV tests.…”

Section: Discussionsupporting

confidence: 90%

Incidence and clinical outcome of icteric type hepatocellular carcinoma

Huang¹,

Wang²,

Zhang³

et al. 2002

J of Gastro and Hepatol

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Section: Discussionsupporting

confidence: 90%

Incidence and clinical outcome of icteric type hepatocellular carcinoma

Huang¹,

Wang²,

Zhang³

et al. 2002

J of Gastro and Hepatol

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“…Since then, a few sporadic reports concerning HCC with bile duct thrombi in a small number of cases have been published. [12][13][14] Many clinicians believed that patients with icteric-type HCC had a poor prognosis compared with that of HCC patients without bile duct thrombosis. Kojiro et al 9 reported that the survival time of 24 patients with intraductal tumor growth was statistically shorter than that of controls among 238 autopsy and 21 surgical cases of HCC.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Characteristics of Hepatocellular Carcinoma with Bile Duct Invasion

Ikenaga

Chijiiwa

Otani

et al. 2009

Journal of Gastrointestinal Surgery

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To clarify the characteristics of hepatocellular carcinoma (HCC) with bile duct invasion, we retrospectively analyzed clinical features and surgical outcome of HCC with bile duct invasion (b(+) group, n = 15) compared to those without bile duct invasion (b(-) group, n = 256). In the b(+) group, four patients (27%) showed obstructive jaundice, and a diagnosis of bile duct invasion was obtained preoperatively in seven patients (47%). The levels of serum bilirubin and carbohydrate antigen 19-9 were significantly higher in the b(+) group. Macroscopically, confluent multinodular type and infiltrative type were predominant in the b(+) group (P = 0.002). Microscopically, capsule infiltration (P = 0.040) and intrahepatic metastasis (P = 0.013) were predominant in the b(+) group. Portal vein invasion was associated significantly with the b(+) group (P = 0.004); however, the frequency of hepatic vein invasion was similar (P = 0.096). The median survival after resection was significantly shorter in the b(+) group than in the b(-) group (11.4 vs. 56.1 months, P = 0.002), and eight of 11 intrahepatic recurrences in the b(+) group occurred within 3 months after surgery. HCC with bile duct invasion has an infiltrative nature and a high risk of intrahepatic recurrence, resulting in poor prognosis.

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“…[1][2][3][4] In most patients, intraductal tumor growth results from direct invasion by HCC, and obstructive jaundice progressively increases. 1 On the other hand, tumor fragments in bile ducts are usually not adherent to the duct wall and can be extracted easily, so the obstructive jaundice sometime fluctuates, possibly because of the intermittent sloughing of necrotic tumor fragments or blood clots.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Instead, jaundice is mainly caused by underlying cirrhosis and/or extensive hepatic parenchymal destruction by the tumor. Some patients with obstructive jaundice can be treated by liver resection, resulting in improved survival.…”

Section: Introductionmentioning

confidence: 97%

Effectiveness of endoscopic biliary drainage for unresectable hepatocellular carcinoma associated with obstructive jaundice

Matsueda

Yamamoto

Umeoka

et al. 2001

Journal of Gastroenterology

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Endoscopic biliary drainage (EBD) for unresectable hepatocellular carcinoma (HCC) associated with obstructive jaundice remains controversial because of the short survival of these patients. To evaluate the effectiveness of this procedure, we retrospectively studied 18 patients who had unresectable HCC with obstructive jaundice and underwent EBD with polyethylene stents, over a 10-year period. Nine patients with tumor thrombus involving the first branches of the portal vein or portal trunk (Vp3) formed group A and the other 9 (Vp0-Vp2) formed group B. The serum albumin level and serum total bililubin level differed significantly between the two groups (P < 0.05 and P < 0.005. Student's t-test), but prothrombin time did not. The obstructive jaundice was mainly caused by direct tumor invasion in 6 patients from group A and 3 from group B, by blood clots and/or tumor fragments in 2 patients from group A and 3 from group B, by the tumor protruding into the common hepatic duct in 2 patients from group B. and by tumor compression of the common bile duct in 1 patient from each group. Drainage was successful in 4 patients (44%) from group A and in all 9 patients (100%) from group B. Among the 5 patients with unsuccessful drainage in group A, 4 had obstruction of both the left and right hepatic ducts and 3 had multiple tumors in both lobes. The mean survival time (mean +/- SD) after EBD was 47 +/- 44 days in group A and 181 +/- 70 days in group B. In group A. the average survival time was only 85 days in the 4 patients with successful drainage. However, an improvement in the quality of life after EBD was observed in one-third of the Vp3 patients and in all of the Vp0-Vp2 patients. In summary, satisfactory palliation is possible with successful EBD, but this is difficult in most patients with Vp3 portal thrombus, direct tumor invasion involving both hepatic ducts, and multiple tumors in both lobes. It is important to determine the site, extent, and nature of the obstruction, as well as liver function and the presence of portal thrombus, before performing EBD.

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Biliary tract invasion and obstruction by hepatocellular carcinoma: report of five cases

Cited by 18 publications

References 15 publications

Incidence and clinical outcome of icteric type hepatocellular carcinoma

Incidence and clinical outcome of icteric type hepatocellular carcinoma

Clinicopathologic Characteristics of Hepatocellular Carcinoma with Bile Duct Invasion

Effectiveness of endoscopic biliary drainage for unresectable hepatocellular carcinoma associated with obstructive jaundice

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