title: Multidisciplinary approach to palliation of obstructive jaundice caused by a central hepatocellular carcinoma.
abstract: OBJECTIVE
  Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC).
  
  
  METHODS
  We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before.
  
  
  RESULTS
  With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved.
  
  
  CONCLUSIONS
  The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland.
authors.forename: J M
authors.initials: JM
authors.lastname: Läuffer
authors.forename: G
authors.initials: G
authors.lastname: Mai
authors.forename: D
authors.initials: D
authors.lastname: Berchtold
authors.forename: C G
authors.initials: CG
authors.lastname: Curti
authors.forename: J
authors.initials: J
authors.lastname: Triller
authors.forename: H U
authors.initials: HU
authors.lastname: Baer
mesh_terms: D000368:Aged; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy*; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D010166:Palliative Care; D010348:Patient Care Team; D015607:Stents; D014057:Tomography, X-Ray Computed