Clinical Characteristics and Surgical Prognosis of Hepatocellular Carcinoma with Bile Duct Invasion

Abstract

Objectives. Bile duct invasion (BDI) is a rare event in hepatocellular carcinoma (HCC). The present study aimed at investigating clinical characteristics and surgical outcome of HCC patients with bile duct invasion. Methods. 413 patients with HCC undergoing curative surgery were divided into two groups with (B+) and without BDI (B−). BDI was further classified as central type (B1) and peripheral type (B2). Survival was compared, and risk factors affecting prognosis were identified. Results. 35 (8.5%) patients were diagnosed BDI. Total bilirubin was significantly higher in B+ group than in B− group (P < 0.001). Multiple lesions and large nodules (>5 cm) were predominantly identified in B+ group (P < 0.01, resp.). Portal vein invasion was more frequently observed in B+ than in B− group (P = 0.003). Univariate and multivariate analyses identified central BDI as a significant factor affecting prognosis of HCC patients (risk 1.3, 95% CI 1.1–2.2, P = 0.015). The gross overall survival of patients in B+ was significantly worse than in B− (P = 0.001), which, however, was not different between B2 and B− (P > 0.05). Conclusions. Central but not peripheral BDI was associated with poorer prognosis of HCC patients. Curative surgical resection of tumors and invaded bile duct supplies the only hope for long-term survival of patients.

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

“…found no significant differences in survival between patients with BDTT and those without BDTT . On the other hand, recent studies including ours, have observed significantly poorer survival outcomes in patients with BDTT after surgery …”

“…Their diagnosis, ideal management and outcomes after a hepatectomy have been an area of speculation and controversy. The incidence of BDTT in HCC varies from 0.8% to 12.5% . In our series, the incidence of BDTT among non‐cirrhotic livers with HCC was 9.1%.…”

“…Obstructive jaundice is an uncommon presenting feature of hepatocellular carcinoma (HCC). The incidence of obstructive jaundice in HCC is in the range of 1% to 12%, with a tumour thrombus in the bile duct (BDTT) being one of the causes . These patients exhibit clinicopathological features which differ from those with parenchymal cholestasis owing to extensive tumour infiltration or advanced cirrhosis .…”

Clinical features and outcomes of patients with hepatocellular carcinoma complicated with bile duct invasion

“…Some previous studies reported poorer surgical outcomes in these patients than in those without bile duct invasion [13,15,31,32]. However, others have reported that some patients with obstructive jaundice can be treated by hepatic resection, with favorable long-term results [7,10,14,26,33].…”

Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus

“…The prognosis of HCC with BDTT is also not well understood . There is controversy whether HCC with BDTT has the same outcomes after hepatectomy as HCC without BDTT . Besides prognosis, evidence is lacking on the preferred method for biliary drainage, extent of hepatectomy and the need for extrahepatic bile duct resection and hepaticojejunostomy (HJ) in these patients .…”