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

Abstract

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.

Typing of biliary tumor thrombus influences the prognoses of patients with hepatocellular carcinoma

“…Identification of this group of patients is clinically important because surgical treatment is usually beneficial 15 . Many studies have confirmed 2 , 16 , 17 that hepatic resection with removal of the BTT is the treatment of choice in selected BTT patients with resectable hepatic tumors, even for those patients presenting with obstructive jaundice.…”

Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Case Report and Literature Review of 890 Patients Affected by Uncommon Primary Liver Tumor Presentation

“…Regarding our literature review, we have extrapolated 20 articles with a total population of 890 patients [ 8 , 9 , 17 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] ( Table 1 and Table 2 ).…”

Prognostic Comparison Between Liver Resection and Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Patients With Bile Duct Tumor Thrombus: A Propensity-Score Matching Analysis

“…Subgroup analysis showed that BDTT patients with low TBIL level could benefit more from surgical resection; therefore, effective preoperative biliary drainage to reduce TBIL level to below 34 μmol/L is essential for surgery and postoperative long-term survival. During the surgery, two operative techniques mentioned in the Surgical Procedure could decrease the recurrence and metastasis rates ( 32 ), especially the peeling off technique, because it avoids the resection of bile duct and enables the administration of postoperative adjuvant therapies against recurrence and metastasis ( 19 ).…”