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Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice
Tatsuya Orimo1, Toshiya Kamiyama2, Hideki Yokoo2
1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. kaorioritatsu@ybb.ne.jp.
Insights
Hepatectomy is a viable treatment for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT), even with obstructive jaundice. Outcomes are comparable to HCC without BDTT when matched for stage.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) can present with bile duct tumor thrombus (BDTT).
- Obstructive jaundice is a potential complication of BDTT in HCC patients.
- Evaluating surgical outcomes for HCC with BDTT is crucial.
Purpose of the Study:
- To assess short- and long-term outcomes of hepatectomy for HCC with BDTT.
- To evaluate the impact of obstructive jaundice on surgical outcomes in these patients.
Main Methods:
- Retrospective review of 42 HCC patients with BDTT and 732 HCC patients without BDTT.
- Analysis of surgical outcomes, including survival rates and perioperative complications.
- Comparison of outcomes between patients with and without BDTT, and between those with and without obstructive jaundice.
Main Results:
- HCC patients with BDTT had advanced stage disease, higher AFP, larger tumors, and more portal vein invasion.
- Unmatched survival was significantly inferior for HCC patients with BDTT.
- Stage-matched survival was similar between HCC patients with and without BDTT.
- Obstructive jaundice did not significantly impact survival or perioperative outcomes in HCC patients with BDTT.
Conclusions:
- Hepatectomy is a recommended treatment for HCC with BDTT, including cases with obstructive jaundice.
- Equivalent surgical outcomes can be achieved for HCC with BDTT compared to HCC without BDTT when matched for stage.
Background:
This study aimed to evaluate the short- and long-term outcomes of hepatectomy for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT), including cases with obstructive jaundice.
Methods:
The study reviewed 42 HCC patients with BDTT, including six patients who needed preoperative biliary drainage due to obstructive jaundice, and 732 HCC patients without BDTT. The authors analyzed the impact of BDTT on the surgical outcomes and assessed the outcomes of hepatectomy for patients presenting with obstructive jaundice.
Results:
The HCC patients with BDTT, almost all with stage 3 or 4 disease, had increased alpha-fetoprotein expression, larger tumors, and more portal vein invasion status. The survival of the HCC patients with BDTT was significantly inferior to that of the patients without BDTT (p = 0.0003). Survival did not differ significantly between the HCC patients with BDTT and those without BDTT when the two groups were matched by stage (p = 0.3366). The HCC patients with BDTT who presented with obstructive jaundice demonstrated outcomes similar to those for the HCC patients with BDTT who did not present with obstructive jaundice in terms of the overall survival rate (p = 0.5469). The perioperative outcomes for the HCC patients with BDTT did not depend on the presence or absence of preoperative jaundice. No patients in either BDTT group demonstrated 90-day mortality in this study.
Conclusions:
Hepatectomy should be considered for HCC patients with BDTT, even for patients with obstructive jaundice, because the surgical outcomes equivalent to those for HCC without BDTT can be achieved.
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