Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management.

Abstract

BACKGROUND:

The aim of this study was to clarify clinicopathologic characteristics of, and to evaluate an aggressive treatment strategy for, hepatocellular carcinoma with biliary tumor thrombi.

METHODS:

From 1980 to 1999, a total of 132 patients underwent hepatectomy for hepatocellular carcinoma. Of these, 17 patients had macroscopic biliary tumor thrombi and were retrospectively analyzed.

RESULTS:

The operative procedures included right hepatic trisegmentectomy (n = 1), right or left hepatic lobectomy (n = 11), and segmentectomy or subsegmentectomy (n = 5). In 13 patients, tumor thrombi extended beyond the hepatic confluence and was treated by thrombectomy through a choledochotomy in 8 patients and extrahepatic bile duct resection and reconstruction in 5 patients. The 3- and 5-year survival rates were 47% and 28%, respectively, with a median survival time of 2.3 years. These survival rates were similar to those achieved in 115 patients without biliary tumor thrombi. In a multivariate analysis, expansive growth type and solitary tumors were independent prognostic variables for favorable outcome after operation, whereas biliary tumor thrombi was not a significant prognostic factor.

CONCLUSIONS:

Surgery after appropriate preoperative management of hepatocellular carcinoma with biliary tumor thrombi yields results similar to those of patients without biliary involvement. Hepatectomy with thrombectomy through a choledochotomy appears to be as effective as a resection procedure.

• Authors: M Shiomi, J Kamiya, M Nagino, K Uesaka, T Sano, N Hayakawa, M Kanai, H Yamamoto, Y Nimura
• Journal: Surgery (Surgery) Vol. 129 Issue 6 Pg. 692-8 (Jun 2001) ISSN: 0039-6060 [Print] United States
• PMID: 11391367 (Publication Type: Journal Article)

Topics

• Bile Duct Neoplasms (mortality, pathology, surgery)
• Carcinoma, Hepatocellular (mortality, pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Liver Neoplasms (mortality, pathology, surgery)
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Thrombosis (mortality, pathology, surgery)