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Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi
M Ueda1, T Takeuchi, T Takayasu
1Second Department of Surgery, Faculty of Medicine, College of Medical Technology, Kyoto University, Japan.
Insights
Hepatocellular carcinoma (HCC) with bile duct thrombi presents a poor prognosis, especially with obstructive jaundice. However, radical surgical treatment may offer improved outcomes for selected cases without jaundice.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Macroscopic bile duct thrombi are rare complications in Hepatocellular Carcinoma (HCC).
- Surgical management of HCC with bile duct thrombi requires careful consideration due to potential poor outcomes.
Observation:
- Out of 542 surgically treated HCC cases, nine (1.66%) exhibited macroscopic bile duct thrombi.
- Three patients with obstructive jaundice and bile duct thrombi underwent surgery, with two succumbing to hepatic insufficiency and one to renal failure and sepsis.
- Six patients diagnosed at earlier stages underwent combined hepatectomy and thrombectomy, showing varied outcomes including recurrence and long-term survival.
Findings:
- Surgical intervention for HCC with bile duct thrombi, particularly when presenting with obstructive jaundice, is associated with a high mortality rate.
- Radical surgical treatment, including hepatectomy and thrombectomy, demonstrated potential for survival in cases without obstructive jaundice.
Implications:
- A classification system for HCC with bile duct thrombi is proposed to guide radical surgical treatment decisions.
- Early diagnosis and surgical intervention for HCC with bile duct thrombi, especially in the absence of obstructive jaundice, may improve patient outcomes.
Abstract:
Nine (1.66%) out of 542 cases of HCC treated surgically in our hospital between 1985 and 1992, had macroscopic bile duct thrombi. Three cases presented preoperatively with obstructive jaundice. Two of these received thrombectomy in the hilar bile duct and died of hepatic insufficiency on postoperative days 10 and 66, the other case underwent extended left lobectomy, but also died of renal failure and sepsis 3 months after the operation. In addition, we also treated 6 cases diagnosed at earlier stages than those presenting with obstructive jaundice with both hepatectomy and thrombectomy. In these patients the outcome was as follows: 2 died of recurrent HCC 3 months and 16 months, respectively, after operation, 1 died of apoplexy with no recurrence after 19 months, 1 had a recurrence 5 months after the operation, but is still alive after 7 months, and 2 are still alive 24 months and 60 months after surgery with no recurrence. The outcome is still poor in our series with obstructive jaundice. But in this report, we propose radical surgical treatment for HCC with bile duct thrombi in accordance with our classification, especially for those cases without obstructive jaundice.