Surgical Strategy of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus

Abstract

Objective: The long-term outcomes of resection for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) have not been well assessed. This study intended to research the surgical strategy of HCC patients with BDTT.

Methods: From February 1994 to December 2012, 877 HCC patients underwent hepatic resection in Ajou University Hospital. Thirty (3.5%) HCC patients with BDTT (Ueda type 3 or 4) were included and retrospective reviewed in this study.

Results: Totally, 20 patients underwent ipsilateral hemihepatectomy. They were divided into two groups: cases underwent hemihepatectomy with extrahepatic bile duct resection (Group 1: n=10) and with only removal of BDTT (Group 2: n=10). Their 1, 3, 5-year overall survival rates were 75.0%, 50.0% and 27.8%, respectively. The 1, 3, and 5-year survival rates of Group 1 were 90.0%, 80.0% and 45.7%, and those of Group 2 were 50.0%, 20.0%, and 10.0%, respectively. (p=0.014) The 1, 3, and 5-year recurrence free survival rates of Group 1 were 90.0%, 70.0% and 42.0%, and those of Group 2 were 36.0%, 36.0% and 0%, respectively. Ipsilateral hemihepatectomy with thrombectomy, infiltrative growth pattern were found as independent prognostic factors for recurrence free survival by multivariate analysis. Ipsilateral hemihepatectomy with thrombectomy, infiltrative growth pattern and high ICG R15 were found as independent prognostic factors for overall survival by multivariate analysis.

Conclusion: We suggested that the adequate surgical procedure for HCC patients with bile duct tumor thrombus should comprise of ipsilateral hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection.