Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus

Abstract

Objective: To identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT). Summary Background Data: Prognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports. Methods: Records of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model. Results: Curative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P < 0.001) and the presence of fibrosis/cirrhosis (P = 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99); P = 0.044 and HR = 0.51 (0.31-0.84); P = 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91); P = 0.018 and HR = 0.61 (0.42-0.89); P = 0.009, respectively]. Conclusions: Clinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.

Outcomes of resection for hepatocellular carcinoma with macroscopic bile duct tumour thrombus: A propensity score matched study

“…Tumour thrombectomy is believed to have potential risks of peritoneal dissemination and recurrence in the preserved bile duct. However, Kim et al ( 37 ) proclaimed that thrombectomy does not significantly increase the risk of peritoneal metastasis. None of the patients who underwent tumour thrombectomy presented with peritoneal dissemination in the present study.…”

“…The absence of bile duct resection for patients with HCC and BDTT may cause recurrence due to direct invasion of the tumour into the bile duct, periductal capillary plexus and lymphatic system ( 27 , 38 ). Recently, a multicentre study reported that bile duct resection was a significant favourable prognostic factor for recurrence, OS and survival after recurrence ( 37 ). Based on the aforementioned studies, the selection criteria for resecting the bile duct could not be too absolute, and an individualized treatment plan was required according to the condition of each patient.…”

<p>Genetic Biomarkers For Hepatocellular Carcinoma In The Era Of Precision Medicine</p>

“…The primary treatment strategy for HCC is to remove the tumor by surgery, but HCC may relapse after the operation. It was reported that the 5-year recurrence rate of HCC after surgery was 74.2% in Japan and Korea 54. Therefore, post-operational monitoring and precise prognosis are necessary for cancer treatment.…”

Efficacy and Safety of Transarterial Chemoembolization for the Treatment of Unresectable Hepatocellular Carcinoma Associated with Bile Duct Tumor Thrombus: A Real-World Retrospective Cohort Study

“…3 Of these causes, BDTT is a rare but special clinical feature of HCC, with the incidence rate of only 1-9%. [4][5][6] With regard to the management of HCC with BDTT, surgical resection has become the main treatment method. Numerous literature have reported that surgical resection can result in better curative effect and improve long-term survival of patients compared to other palliative-intent therapy.…”