Hepatocellular Carcinoma with Tumor Thrombi in Bile Duct

Abstract

Background/Aims: Hepatocellular carcinoma presented as obstructive jaundice caused by tumor thrombi in bile duct is rare. The authors report on clinical experiences and evaluate the results of different treatment modalities for this

disease.

Methods and Results: Eight(3.6%) of 224 patients with hepatocellular carcinoma treated in our hospital between June 1994 and January 1996, had macroscopic bile duct thrombi. All cases were presented preoperatively with obstructive

jaundice. Seven of them were diagnosed preoperatively with hepatocellular carcinoma through endoscopic biopsy during ERCP. Six of 8 patients underwent exploratory laparotomy: right lobectomy with extra-hepatic bile duct resection in two cases; right lobectomy with tumor thrombectomy in two cases; T-tube drainage in one case ; and biopsy only, in one case. Of these patients, the T-tube drainage case died 14 months after operation under repeat TAE, and the biopsy only case died of recurrent cholangitis and sepsis 8 months after PTBD. The right lobectomy and thrombectomy patients developed early recurrence within 3 months after surgery; one died due to repeated cholangitis and sepsis attack after internal stent insertion 5 months after hepatectomy, and the other died of esophageal varix bleeding and liver failure 5 months after surgery. The two patients of right lobectomy with extra-hepatic bile duct resection are still alive 15 months and 14 months without recurrence, respectively.

Conclusion: Although the outcome of icteric hepatoma is still poor and the number of patients is small in our series, our results suggest that 1) For the improvement of survival, it seems necessary to perform major hepatic resection with removal or extrahepatic bile duct; 2) If it is impossible due to limited liver function, non-surgical modalities should be considered instead of surgery because no differences of prognosis between the two groups exists.