Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Wong, Tiffany C.L.; Cheung, Tan To; Chok, Kenneth S.H.; Chan, Albert C.Y.; Dai, Wing Chiu; Chan, See Ching; Poon, Ronnie T.P.; Fan, Sheung Tat; Lo, Chung Mau
• Is Part Of: HPB. Volume 17:Issue 5(2015:May)
• Page Start: 401
• Page End: 408
• Publication Date: 2015-05
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12368
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Hepatocellular carcinoma (HCC) with bile duct tumour thrombus (BDTT) is rare. The aim of the present study was to determine the prognosis of HCC with BDTT after a hepatectomy. Methods: A retrospective analysis was performed on all HCC patients with BDTT having a hepatectomy from 1989 to 2012. The outcomes in these patients were compared with those in the control patients matched on a 1:6 ratio. Results: Thirtyseven HCC patients with BDTT having a hepatectomy (the BDTT group) were compared with 222 control patients. Patients in the BDTT group had poorer liver function (43.2% had Child–Pugh B disease). More patients in this group had a major hepatectomy (91.9% versus 27.5%, P = 0.001), portal vein resection (10.8% versus 1.4%, P = 0.006), enbloc resection with adjacent structures (16.2% versus 5.4%, P = 0.041), hepaticojejunostomy (75.7% versus 1.6%, P < 0.001) and complications (51.4% versus 31.1%, P = 0.016). The two groups had similar hospital mortality (2.7% versus 5.0%, P = 0.856), 5year overall survival (38.5% versus 34.6%, P = 0.59) and 5year diseasefree survival (21.1% versus 20.8%, P = 0.81). Multivariate analysis showed that lymphovascular permeation, tumour size and postoperative complication were significant predictors for worse survival whereas BDTT was not. Discussion: A major hepatectomy, extrahepatic biliary resection and hepaticojejunostomy should be the standard for HCC with BDTT, and longterm survival is possible after radical surgery.