title: Surgical outcomes of hepatocellular carcinoma with biliary tumor thrombus: a systematic review.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) with biliary tumor thrombus (BTT) is rare and its impact on postoperative prognosis remains controversial. The aim of this study was to evaluate the published evidence concerning the outcome of surgical resection of HCC with BTT.
  
  
  METHODS
  Eligible studies were identified by searching PubMed and reviewed systematically. Comparisons of the clinicopathologic features and surgical outcomes for HCC patients with or without BTT were analyzed using meta-analytical techniques.
  
  
  RESULTS
  Twenty retrospective studies containing 598 patients that met the selection criteria were included for review. The perioperative mortality was 2.1 % (range, 0-10 %), and the median 5-year overall survival (OS) was 24 % (range, 0-48 %) with a recurrence rate of 63.9 % (range, 42-91 %). Pooled analysis of 13 comparative studies showed that HCC patients with BTT had a higher incidence of vascular invasion (odds ratio [OR]: 4.70, 95 % CI: 2.90-7.60; P <0.001), a higher frequency of poor differentiation (OR: 2.07, 95 % CI: 1.23-3.49; P = 0.006), and a shorter 5-year OS rate (OR: 0.31, 95 % CI: 0.21-0.64; P <0.001) than those without BTT.
  
  
  CONCLUSIONS
  Although HCC with BTT has more aggressive biological characteristics and is an indicator of poor prognosis, surgical resection can still provide long-term survival for some patients.
authors.affiliation: Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, China. lzwhq1968@sina.cn.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Qiao
authors.affiliation: Department of Hepatobiliary Surgery, No.101 Hospital of CPLA, Wuxi, China. 22896201@qq.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Hepato-Biliary-Pancreato-Vascular Surgery, First affiliated Hospital of Xiamen University, Xiamen, China. wulp1986@sina.cn.
authors.forename: Lupeng
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Hepato-Biliary-Pancreato-Vascular Surgery, First affiliated Hospital of Xiamen University, Xiamen, China. Binl1962@sina.cn.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Hepato-Biliary-Pancreato-Vascular Surgery, First affiliated Hospital of Xiamen University, Xiamen, China. zhouymsxy@sina.cn.
authors.forename: Yanming
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*
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