Hepatocellular carcinoma with tumor thrombi in the bile duct

Hepatocellular carcinoma (HCC), presenting as obstructive jaundice caused by tumor thrombi in the bile duct, is rare. The authors report on clinical experiences and evaluate the results of different treatment modalities for this disease.

We experienced 549 cases of HCC at Ajou University Hospital from June 1994 through January 1998. Among them, 10 cases with gross evidence of tumor thrombi in the bile duct were treated with different resection methods and interventions, and then compared with those receiving short-term results.

Eight out of 10 patients underwent exploratory laparotomy: right lobectomy with extrahepatic bile duct resection in 2 cases; right lobectomy with tumor thrombectomy in 2 cases; left lobectomy and caudate lobectomy with extra-hepatic bile duct resection in 2 cases: T-tube drainage in 1 case and biopsy only with post-operative internal biliary stent, in 1 case. Survival times of these patients were 39 months (still alive); 38 months (still alive); 8 months (died); 8 months (died); 8 months (still alive); 1 month (still alive); 14 months (died); 8 months (died), respectively. Of the 2 non-surgical cases, 1 underwent PTBD only and the other had endoscopic removal of the thrombi. Their survival times were 18 days (died) and 24 months (still alive with recurrence), respectively. The 4 cases, with right lobectomy or left lobectomy including extrahepatic bile duct resection, had relatively long-term disease-free survival (39 months, 38 months, 8 months and 1 month after operation, respectively). However, there were no differences in survival between the partial hepatectomy procedure with removal of tumor thrombi and the simple drainage procedure without tumor resection.

Although the number of patients in this study is small, our results suggest that: 1) For the improvement of survival, it seems necessary to perform major hepatic resection with removal of the extrahepatic bile duct. 2) If hepatic resection cannot be accomplished with bile duct resection due to limited liver function, non-surgical modalities should be considered instead of surgery because no differences in prognosis between the 2 groups exist.