Surgical treatment of hepatocellular carcinoma with bile duct tumor thrombi

Abstract

Abstract Abstract AbstractAIM: To study the surgical treatment effect and outcome of hepatocellular carcinoma (HCC) with bile duct tumor thrombi (BDTT). METHODS:Fifty-three consecutive HCC patients with BDTT admitted in our department from July 1984 to December 2002 were reviewed retrospectively. The clinical data, diagnostic methods, surgical procedures and outcome of these patients were collected and analyzed. RESULTS:One patient rejected surgical treatment, 6 cases underwent percutaneous transhepatic cholangial drainage (PTCD) for unresectable primary disease, and the other 46 cases underwent surgical operation. The postoperative mortality was 17.6%, and the morbidity was 32.6%. Serum total bilirubin levels of these patients with obstructive jaundice decreased gradually after surgery. The survival time of six cases who underwent PTCD ranged from 2 to 7 mo (median survival of 3.7 mo). The survival time of the patients who received surgery was as follows: 2 mo for one patient who underwent laparotomy, 5-46 mo (median survival of 23.5 mo, which was the longest survival in comparison with patients who underwent other procedures, P = 0.0024) for 17 cases who underwent hepatectomy, 5-17 mo (median survival of 10.0 mo) for 5 cases who underwent HACE, 3-9 mo (median survival of 6.1 mo) for 11 cases who underwent simple thrombectomy and biliary drainage, and 3-8 mo (median survival of 4.3 mo) for four cases who underwent simple biliary drainage. CONCLUSION:Jaundice caused by BDTT in HCC patients is not a contraindication for surgery. Only curative resection can result in long-term survival. Early diagnosis and surgical treatment are the key points to prolong the survival of patients.

Clinicopathological Characteristics of 20 Cases of Hepatocellular Carcinoma with Bile Duct Tumor Thrombi

“…Peng et al [8] also reported that it is easy to remove BDTT because most of thrombi do not tightly adhere to the wall of the bile duct. In our study, the tumor thrombi were always fragile, fleshy, grayish-white, and located along the biliary tree, which was in agreement with the reports of Edmondson some 50 years ago [21].…”

“…Previous reports have demonstrated that BDTT was often present when the primary tumor was very small. Peng et al [8] reported that in 53 cases of HCC with BDTT, the primary tumor was not found in seven cases, and the diameter of the primary tumor was less than 5 cm in 25 cases. Qin et al [9] reported that in 34 cases of such tumors, the diameter of the primary tumor was 6.4 ± 2.5 cm and all of the primary tumors had no capsule, unclear tumor margins, and an invasive pattern of growth.…”

“…Patients with this kind of tumor often present with jaundice as the initial complaint and are sometimes misdiagnosed as cholangiocarcinoma or choledocholithiasis [3][4][5][6][7][8]. Mallory et al [13] reported the first such case in 1947, in which HCC invaded the cystic duct and gave rise to obstructive jaundice caused by hemobilia from the tumor thrombi.…”

“…Several research centers have reported that BDTT might occur when the primary tumor is very small [8,9]. However, the mechanism of BDTT formation is still unclear, and its clinical and pathological characteristics remain to be defined.…”

“…HCC with bile duct tumor thrombi (BDTT) is a rare event; its incidence is approximately 1.2-9.0% [3][4][5][6][7][8]. Several research centers have reported that BDTT might occur when the primary tumor is very small [8,9].…”