title: Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korean multicenter study.
abstract: BACKGROUND
  The long-term outcomes after resection for hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT) are unclear. This multicenter study was conducted to determine the prognosis of HCC patients with macroscopic BDTT who underwent resection with curative intent.
  
  
  METHODS
  Of 4,308 patients with HCC from four Korean institutions, this single-arm retrospective study included 73 patients (1.7 %) who underwent resection for HCC with BDTT.
  
  
  RESULTS
  Jaundice was also present in 34 patients (46.6 %). According to Ueda classification, BDTT was type 2 in 34 cases (46.6 %) and type 3 in 39 cases (53.4 %). Biliary decompression was performed in 33 patients (45.2 %), decreasing the median lowest bilirubin level to 1.4 mg/dL before surgery. Systematic hepatectomy was performed in 69 patients (94.5 %), and concurrent bile duct resection was performed in 31 patients (42.5 %). Surgical curability types were R0 (n = 57; 78.1 %), R1 (n = 11; 15.1 %), and R2 (n = 5; 6.8 %). Patient survival rates were 76.5 % at 1 year, 41.4 % at 3 years, 32.0 % at 5 years, and 17.0 % at 10 years. Recurrence rates were 42.9 % at 1 year, 70.6 % at 3 years, 77.3 % at 5 years, and 81.1 % at 10 years. Results of univariate survival analysis showed that maximal tumor size, bile duct resection, and surgical curability were significant risk factors for survival, and surgical curability was a significant risk factor for recurrence. Multivariate analysis did not reveal any independent risk factors.
  
  
  CONCLUSIONS
  Hepatocellular carcinoma patients with BDTT achieved relatively favorable long-term results after resection; therefore extensive surgery should be recommended when complete resection is anticipated.
authors.affiliation: Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Gu, Seoul 138-736, Korea.
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Wang
authors.forename: Sung-Su
authors.initials: SS
authors.lastname: Yun
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Yong-Keun
authors.initials: YK
authors.lastname: Park
authors.forename: Weiguang
authors.initials: W
authors.lastname: Xu
authors.forename: Bong-Wan
authors.initials: BW
authors.lastname: Kim
authors.forename: Dong Shik
authors.initials: DS
authors.lastname: Lee
authors.forename: Dong-Hyun
authors.initials: DH
authors.lastname: Lee
authors.forename: Hong-Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Lim
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Yo-Han
authors.initials: YH
authors.lastname: Park
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002779:Cholestasis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome