title: Bile duct thrombi in hepatocellular carcinoma: is aggressive surgery worthwhile?
abstract: BACKGROUND
  Obstructive jaundice as a result of bile duct tumour thrombus (BDTT) is an unusual clinical entity and an uncommon presenting feature of hepatocellular carcinoma (HCC). This study evaluates the outcome of hepatectomy for HCC with obstructive jaundice as a result of BDTT in non-cirrhotic livers.
  
  
  METHODS
  Between 1997 and 2012, out of 426 patients with HCC in non-cirrhotic livers, 39 patients with BDTT (Group I n = 39), who underwent a hepatectomy, were analysed and compared with the non-BDTT group (Group II n = 387).
  
  
  RESULTS
  The demographic profile and biochemical parameters between Group I and Group II were compared; apart from the presence of jaundice at presentation and an elevated serum bilirubin, there were no significant differences. Post-operative morbidity and mortality were 11 (28.2%) and 2 (5.1%), respectively, in Group I. There were no differences between the groups with regards to the operative variables and short-term outcomes. The 1-, 3- and 5-year survival rates in Group I were 82%, 48% and 10%, respectively, with a median survival of 28.6 months and were significantly poorer than Group II (90%, 55% and 38%, respectively, with a median survival of 39.2 months).
  
  
  CONCLUSIONS
  The mere presence of BDTT in HCC does not indicate an advanced or inoperable lesion. When technically feasible, a formal hepatic resection is the preferred first-line treatment option in these patients.
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Ashwin
authors: A
authors: Rammohan
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Jeswanth
authors: J
authors: Sathyanesan
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Kamalakannan
authors: K
authors: Rajendran
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Anbalagan
authors: A
authors: Pitchaimuthu
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Senthil K
authors: SK
authors: Perumal
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Kesavan
authors: K
authors: Balaraman
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Ravi
authors: R
authors: Ramasamy
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Ravichandran
authors: R
authors: Palaniappan
authors: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital Chennai, India.
authors: Manoharan
authors: M
authors: Govindan
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
references: World J Surg Oncol. 2011;9:2
references: 21214943
references: Surgery. 2001 Jun;129(6):692-8
references: 11391367
references: Ann Surg. 1997 Mar;225(3):281-5
references: 9060584
references: J Gastrointest Surg. 2009 Mar;13(3):492-7
references: 19011945
references: Surgery. 2000 Nov;128(5):779-83
references: 11056440
references: J Gastroenterol Hepatol. 2002 Feb;17(2):190-5
references: 11966950
references: World J Surg. 2004 Jan;28(1):43-6
references: 14639491
references: World J Gastroenterol. 2004 May 15;10(10):1397-401
references: 15133842
references: World J Surg. 2004 May;28(5):471-5
references: 15085398
references: Dig Dis Sci. 2011 Jan;56(1):252-9
references: 20437099
references: Hepatogastroenterology. 1994 Aug;41(4):349-54
references: 7959570
references: World J Gastroenterol. 2011 Nov 21;17(43):4817-24
references: 22147984
references: J Surg Oncol. 2005 Jun 15;90(4):226-32
references: 15906365
references: Transplant Proc. 2006 Sep;38(7):2093-4
references: 16980009
references: World J Surg. 2013 Feb;37(2):443-51
references: 23188531
references: Gastroenterol Res Pract. 2014;2014:604971
references: 24723944
references: World J Gastroenterol. 2003 Mar;9(3):385-91
references: 12632482