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

Kasai, Yosuke; Hatano, Etsuro; Seo, Satoru; Taura, Kojiro; Yasuchika, Kentaro; Üemoto, Shinji

doi:10.1007/s00268-015-2985-9

Cited by 34 publications

(48 citation statements)

References 35 publications

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“…Kasai et al have reported previously that major vascular invasion is a negative prognostic indicator for HCC patients with BDTT. 18 These results suggest that BDTT alone does not affect prognosis and only does so in conjunction with other prognostic factors, such as vascular invasion, poor differentiation, or large size.…”

Section: -8 Yeh Et Al Reported the Relationship Between The Pathogenmentioning

confidence: 69%

“…7 However, according to several reports, routine bile duct resection is not recommended unless direct invasion of the BDTT into the bile duct is suspected. 8,12,18 Shiomi et al reported that the survival of their bile duct-preserved group was similar to that of their bile duct-resected group. 19 Recently, Yamamoto et al reported using bile duct-preserving surgery for HCC with BDTT-called the "peeling off technique"…”

Section: -8 Yeh Et Al Reported the Relationship Between The Pathogenmentioning

confidence: 99%

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Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice

et al. 2016

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SynopsisHepatectomy should be considered for hepatocellular carcinoma with bile duct tumor thrombus.3 Abstract Purpose: The purpose of this study was to evaluate the short-and long-term outcomes of hepatectomy for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT), including cases with obstructive jaundice. Methods:We reviewed 42 HCC patients with BDTT, including 6 patients who needed preoperative biliary drainage due to obstructive jaundice and 732 HCC patients without BDTT. We analyzed the impact of BDTT on the surgical outcomes and assessed the outcomes of hepatectomy for patients presenting with obstructive jaundice.

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Section: -8 Yeh Et Al Reported the Relationship Between The Pathogenmentioning

confidence: 69%

Section: -8 Yeh Et Al Reported the Relationship Between The Pathogenmentioning

confidence: 99%

Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice

et al. 2016

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“…Surprisingly, our study found 12.5% lymph node metastasis in HCC with HBDTT, which is higher than those reported in previous literatures. Some studies had mentioned higher incidence of lymphovascular invasion in HCC with BDTT than HCC without BDTT [41,42]. This finding is unexpected and may suggest that HCC with HBDTT is more aggressive via lymphatic metastasis.…”

Section: Discussionmentioning

confidence: 88%

Hepatocellular carcinoma with hilar bile duct tumor thrombus versus hilar Cholangiocarcinoma on enhanced computed tomography: a diagnostic challenge

et al. 2020

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Background: Hepatocellular carcinoma (HCC) with hilar bile duct tumor thrombus (HBDTT) often mimic hilar cholangiocarcinoma (hilar CC). The purpose of this study is to analyze the Computed Tomography (CT) characteristics of HCC with HBDTT and to identify imaging features to aid its differentiation from hilar CC on enhanced CT. Methods: We retrospectively identified 58 cases with pathologically proved HCC with HBDTT between 2011 and 2018. Seventy-seven cases of pathologically proven hilar CCs were selected during the same period. The clinical features and CT findings of the two groups were reviewed and compared. Results: HCC with HBDTTs are more commonly found in men (87.9% vs 63.6%, p = 0.001) with lower age of onset (49.84 vs 58.61 years; p < 0.001) in comparison to hilar CCs. Positive correlation were identified between HCC with HBDTTs and chronic HBV infection (72.4% vs 11.7%; p < 0.001), increased serum AFP (67.2% vs 1.3%; p < 0.001), CA19-9 level (58.6% vs 85.7%; p < 0.001) and CEA level (3.4% vs 29.9%; p = 0.001), parenchymal lesion with intraductal lesion (100% vs 18.2%; p < 0.001), washout during the portal venous phase (84.5% vs 6.5%; p < 0.001), thickened bile duct wall (8.6% vs 93.5%; p < 0.001), intrahepatic vascular embolus (44.8% vs 7.8%; p < 0.001), splenomegaly (34.5% vs 2.6%, p < 0.001). A scoring system consisting of the five parameters obtained from characteristics mentioned above was trialed. The sensitivity and specificity for diagnosing HCC with HBDTT were 96.39, 100 and 92.5% respectively when the total score was 2 or more. Conclusions: HCC with HBDTTs are often distinguishable from hilar CCs based on washout during portal venous phase without thickened bile duct wall. HBV infection and serum AFP level facilitate the differentiation.

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“…Cholangitis and hemobilia, which often develop in association with bile duct invasion, are also immediate threats to survival. In addition, HCC involvement of the bile duct could theoretically be accompanied by portal vein thrombosis, which is one of the worst prognostic factors for HCC patients [12]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Background/AimsLittle is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion.MethodsA total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included.ResultsThe majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39, Ps <0.001, respectively).ConclusionsThe survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.

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

Abstract: 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.

Cited by 34 publications

References 35 publications

Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice

Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice

Hepatocellular carcinoma with hilar bile duct tumor thrombus versus hilar Cholangiocarcinoma on enhanced computed tomography: a diagnostic challenge

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

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