Neoadjuvant Transcatheter Arterial Chemoembolization for Biliary Tumor Thrombosis: A Retrospective Study

Abstract

Objectives: Curative hepatectomy and tumor thrombectomy for hepatocellular carcinoma with complicating biliary tumor thrombosis (HCC/BTT) is associated with high surgical morbidity and mortality. This retrospective study evaluated the effectiveness and safety of neoadjuvant transcatheter arterial chemoembolization (TACE) in HCC/BTT patients scheduled for curative resection. Methods: Thirty consecutive patients with diagnosed HCC/BTT were hospitalized for neoadjuvant TACE and elective curative liver resection (group A; n = 20) or curative liver resection alone (group B; n = 10). The primary outcome measure was median survival. Results: Group A had a significantly shorter overall operative time (160 ± 25 versus 190 ± 35 min; p < .01) and duration of inflow control (14.3 ± 3.6 versus 25.1 ± 5.1 min; p < .01) and significantly less intraoperative blood loss (150 ± 35 versus 520 ± 75 ml; p < .01) and transfusion (100 ± 40 versus 375 ± 55 ml; p < .01) as compared to group B. Among patients undergoing both thrombectomy and curative resection, the median survival of group A was significantly longer than that of group B (28.5 [9-54] versus 21.5 [6-39] months; p < .01); among those who received thrombectomy alone, the median survival of group A was also significantly longer than that of group B (12.8 [6-25] versus 4.5 [2-7] months; p < .01). Conclusions: Neoadjuvant TACE significantly reduced the surgical risk of curative liver resection and significantly prolonged median survival in HCC patients with complicating BTT.

A nomogram based on combining systemic and hepatic inflammation markers for predicting microscopic bile duct tumour thrombus in hepatocellular carcinoma

“…The presence of micro-BDTT should, therefore, be considered an adverse prognostic factor after hepatectomy. Surgical treatment for HCC is considered the most effective approach, including those with BDTT; however, the surgical strategy for HCC with BDTT has not been clearly de ned in previous studies [30][31][32]. However, Kasai et al had showed that in HCC patients with BDTT alone without MVI, extended hepatectomy provided a better prognosis [31].…”

“…However, Kasai et al had showed that in HCC patients with BDTT alone without MVI, extended hepatectomy provided a better prognosis [31]. In addition, neoadjuvant transcatheter arterial chemoembolization (TACE) reduced the surgical risk of curative liver resection and signi cantly prolonged median survival in patients with HCC with BDTT [32]. Luo et al also showed that for HCC patients with BDTT, radical hepatic resection and removal of BDTT, combined with TACE, are the best approach [33].…”

A nomogram based on combining systemic and hepatic inflammation markers for predicting microscopic bile duct tumor thrombus in hepatocellular carcinoma

“…Surgical treatment for HCC is considered as the most effective approach, including those with BDTT, and the surgical strategy in HCC with BDTT is not clearly de ned in previous studies [30][31][32]. However, Kasai et al had showed that in HCC patients with BDTT alone without MVI, extended hepatectomy provided a better prognosis [31].…”

“…However, Kasai et al had showed that in HCC patients with BDTT alone without MVI, extended hepatectomy provided a better prognosis [31]. In addition, neoadjuvant TACE reduced the surgical risk of curative liver resection and signi cantly prolonged median survival in HCC with BDTT [32]. Luo et al had also showed that for HCC patients with BDTT, radical hepatic resection and removal of BDTT, combined with TACE, are the best approach [33].…”