Hepatocellular Carcinoma with Obstructive Jaundice: Endoscopic and Percutaneous Biliary Drainage

Abstract

Among patients with later stage hepatocellular carcinoma (HCC), only 1–12% manifest obstructive jaundice as the initial complaint. Endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic biliary drainage (PTBD) are the two main non-surgical treatment options for obstructive jaundice in patients with HCC. ERBD is usually the first-line treatment because of its low hemorrhage risk. Some have reported that the successful drainage rate ranges from 72 to 100%. Mean stent patency time and mean survival range from 1.0 to 15.9 and 2.8 to 12.3 months, respectively. PTBD is often an important second-line treatment when ERBD is impossible. With regard to materials, metallic stents offer the benefit of longer patency than plastic stents. The dominant effect of biliary drainage suggests that successful jaundice therapy could enhance anti-cancer treatment by increasing life expectancy, decreasing mortality, or both. We present an overview of the efficacy of endoscopic and percutaneous drainage for obstructive jaundice in patients with HCC who are not candidates for surgical resection and summarize the current indications and outcomes of reported clinical use.

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

“…2 HCC with BDTT showing obstructive jaundice leads to severe symptoms such as cholangitis and hemobilia, and can cause hepatic failure. [3][4][5] However, it is difficult to determine the surgical indications for patients with obstructive jaundice because jaundice due to advanced liver cirrhosis is a contraindication for hepatectomy. There have been several studies on HCC with BDTT and it is clear that surgical approach for HCC with…”

“…[3][4][5] Therefore, biliary drainage is mandatory before hepatectomy for patients with BDTT that present with obstructive jaundice. We perform preoperative biliary drainage at our hospital in accordance with the preoperative management of biliary tract cancer.…”

Tumor emboli from intrahepatic cholangiocarcinoma causing obstructive jaundice

“…1 It is due to obstruction of the bile duct through blood clot, biliary sludge, tumor compression or infiltration and cancer embolus. Jaundice due to tumor embolism to the common bile duct is very rare.…”

Role of Endoscopic Biliary Drainage in Advanced Hepatocellular Carcinoma with Jaundice

“…Jaundice, which is associated with poor patient prognosis, is usually caused by diffuse tumor infiltration into the liver parenchyma, hilar invasion, and/or progressive terminal liver failure resulting from advanced underlying cirrhosis [1][2][3][4][5][6][7][8]. Obstructive jaundice, however, is uncommon, with only 0.5-13% of patients with HCC displaying definite obstructive jaundice.…”

“…Although several studies have assessed the effects of endoscopic or percutaneous palliation of obstructive jaundice in small numbers of patients with HCC [1][2][3][4][5][6][7][8], few reports have assessed the effectiveness and durability of direct endoscopic biliary drainage without nasobiliary drainage in HCC patients with obstructive jaundice. This study therefore evaluated whether endoscopic biliary drainage could improve survival and offer the chance of subsequent HCC treatment in patients with HCC and obstructive jaundice, even in the absence of evident signs of obstruction.…”