Surgical treatment for hepatocellular carcinoma with bile duct invasion

Abstract

PurposeThere is still some debate on surgical procedures for hepatocellular carcinoma (HCC) patients with bile duct tumor thrombi (BDTT, Ueda type 3 or 4). What is adequate extent of liver resection for curative treatment? Is extrahepatic bile duct resection mandatory for cure? The aim of this study is to answer these questions.MethodsBetween February 1994 and December 2012, 877 consecutive HCC patients underwent hepatic resection at Ajou University Hospital. Thirty HCC patients (3.4%) with BDTT (Ueda type 3 or 4) were retrospective reviewed in this study.ResultsIn total, 20 patients enrolled in this study were divided into 2 groups: patients who underwent hemihepatectomy with extrahepatic bile duct resection (group 1, n = 10) and with only removal of BDTT (group 2, n = 10). The 1-, 3- and 5-year overall survival rates were 75.0%, 50.0%, and 27.8%, respectively. The 1-, 3-, and 5-year survival rates of group 1 were 100.0%, 80.0%, and 45.7%, and those of group 2 were 50.0%, 20.0%, and 10.0%, respectively (P = 0.014). The 1-, 3-, and 5-year recurrences free survival rates of group 1 were 90.0%, 70.0%, and 42.0%, and those of group 2 were 36.0%, 36.0%, and 0%, respectively (P = 0.014). Thrombectomy and infiltrative growth type (Ig) were found as independent prognostic factors for recurrence free survival by multivariate analysis. Thrombectomy, Ig, and high indocyanine green retention rate at 15 minutes were found as independent prognostic factors for overall survival by multivariate analysis.ConclusionWe suggest that the appropriate surgical procedure for icteric HCC patients should be comprised of ipsilateral hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection.

Intrahepatic Cholangiocarcinoma Involving the Hepatocaval Confluence with Bile Duct Tumor Thrombus Mimicking a Klatskin Tumor: A Case Report

“…The presence of bile duct tumor thrombus associated to ICC is a very rare finding, being more common in case of hepatocellular carcinoma (2-9%) (27,28). Indeed, we found only 7 such former case reports after reviewing the literature (29,30,31).…”

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

“…Depending on the location of the HCC and BDTT, HCC resection or hemihepatectomy plus thrombectomy through choledochotomy is chosen. In cases where the BDTT is firmly attached to or even invades the extrahepatic bile duct wall, extrahepatic bile duct resection should be considered (15,18,19). In the current study, 2 patients who underwent HCC resection and thrombectomy through a choledochotomy had recurrence of the tumor thrombus in the left hepatic duct within 6 months after surgery, which resulted in multiple tumors in the residual left lobe of the liver.…”

Mass-forming intrahepatic cholangiocarcinoma with portal vein tumor thrombus and bile duct tumor thrombus: A case report

“…PVTT and BDTT occur more frequently in HCC than ICC. Reports show that the incidence of HCC with PVTT ranges from 14 to 44% [4] , [9] , [10] , and HCC with BDTT ranges from 2 to 9% [1] , [2] , [3] , [11] . Conversely, ICC with BDTT or PVTT is rare.…”

“…In HCC, BDTT loosely attaches to the bile duct epithelium. Because of this, systematic hepatectomy and thrombectomy through choledochotomy are often performed for HCC with BDTT, without resection of the bile duct [2] , [3] , [12] . Furthermore, extended lobectomy, lymph node dissection, extrahepatic bile duct resection, and reconstruction are recommended for ICC with BDTT; this is because ICC is a malignant tumor that originates from cholangiocytes and commonly infiltrates into the bile duct [5] , [13] .…”

“…Portal vein tumor thrombus (PVTT) and bile duct tumor thrombus (BDTT) are pathognomonic for hepatocellular carcinoma (HCC) [1] , [2] , [3] , [4] . Intrahepatic cholangiocarcinoma (ICC) commonly infiltrates into the portal vein or bile duct [5] , [6] .…”