Surgery of hepatocellular carcinoma complicated with cancer thrombi in bile duct: efficacy for criteria for different therapy modalities.
OBJECTIVE
This study retrospectively compared different therapy modalities in patients with hepatocellular carcinoma (HCC) complicated by bile duct thrombi (BDT).


METHODS
A total of 184 patients with BDT were selected from a pool of 12,114 patients with HCC, and their cases were reviewed in this study.


RESULTS
The occurrence rate of BDT was 1.84% (223/12,114) in our study. The radical resection rate in types I, II, III, and IV was 70% (7/10), 38.46% (10/26), 20.4% (29/142), 33.3% (2/6), respectively. The mean survival time in patients who underwent radical hepatic resection and BDT removal (group A), palliative hepatectomy and BDT removal (group B), palliative hepatectomy and BDT removal plus unilateral liver artery ligation or postoperative transcatheter arterial chemoembolization (TACE; group C), TACE (group D), drainage to relieve the jaundice by ERCP or PTCD (group E), and conservative treatment (group F) was 37, 6, 16, 11, 3.0, 3.0 months, respectively. The survival rate of patients in group A was significantly greater than in other group (P < 0.0001); the rate in groups C and D was significantly higher than that in groups B, E, and F (P < 0.001). In group A, 1-year recurrence rate was 20.8% (10/48). One patient with severe jaundice suffered chronic liver failure after right lobe resection and died 2 months after operation. In groups B, C, D, E, and F, in ten cases, cholangitis occurred, in eight cases, hemobilia occurred, and 72 of 136 patients suffered liver failure and died within 6 months. Five patients underwent orthotopic liver transplantation; at the time of writing, three patients are still alive, and the longest survivor has now survived for 37 months since undergoing transplantation.


CONCLUSIONS
Radical hepatic resection and removal of BDT, combined with TACE, are the best approach for treating HCC patients with BDT. Biliary drainage to relieve the jaundice is critical.
Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Luo
L
Xiangji
Tan
T
Weifeng
Yi
Y
Bin
Liu
L
Chen
Jiang
J
Xiaoqing
Zhang
Z
Baihe
Shen
S
Feng
Wu
W
Mengchao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001650:Bile Duct Neoplasms / Q000556:secondary* / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents