Ann Surg Treat Res.  2016 Mar;90(3):139-146. 10.4174/astr.2016.90.3.139.

Surgical treatment for hepatocellular carcinoma with bile duct invasion

• Hu XG
• Mao W
• Hong SY
• Kim BW
• Xu WG
• Wang HJ

• KMID: 2155047
• DOI: http://doi.org/10.4174/astr.2016.90.3.139

Abstract

PURPOSE
There is still some debate on surgical procedures for hepatocellular carcinoma (HCC) patients with bile duct tumor thrombi (BDTT, Ueda type 3 or 4). What is adequate extent of liver resection for curative treatment? Is extrahepatic bile duct resection mandatory for cure? The aim of this study is to answer these questions.
METHODS
Between February 1994 and December 2012, 877 consecutive HCC patients underwent hepatic resection at Ajou University Hospital. Thirty HCC patients (3.4%) with BDTT (Ueda type 3 or 4) were retrospective reviewed in this study.
RESULTS
In total, 20 patients enrolled in this study were divided into 2 groups: patients who underwent hemihepatectomy with extrahepatic bile duct resection (group 1, n = 10) and with only removal of BDTT (group 2, n = 10). The 1-, 3- and 5-year overall survival rates were 75.0%, 50.0%, and 27.8%, respectively. The 1-, 3-, and 5-year survival rates of group 1 were 100.0%, 80.0%, and 45.7%, and those of group 2 were 50.0%, 20.0%, and 10.0%, respectively (P = 0.014). The 1-, 3-, and 5-year recurrences free survival rates of group 1 were 90.0%, 70.0%, and 42.0%, and those of group 2 were 36.0%, 36.0%, and 0%, respectively (P = 0.014). Thrombectomy and infiltrative growth type (Ig) were found as independent prognostic factors for recurrence free survival by multivariate analysis. Thrombectomy, Ig, and high indocyanine green retention rate at 15 minutes were found as independent prognostic factors for overall survival by multivariate analysis.
CONCLUSION
We suggest that the appropriate surgical procedure for icteric HCC patients should be comprised of ipsilateral hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection.

Keyword

Hepatocellular carcinoma; Cholestasis; Hepatectomy

MeSH Terms

Bile Ducts*
Bile Ducts, Extrahepatic
Bile*
Carcinoma, Hepatocellular*
Cholestasis
Hepatectomy
Humans
Indocyanine Green
Liver
Multivariate Analysis
Recurrence
Retrospective Studies
Survival Rate
Thrombectomy
Indocyanine Green

Figure

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  Fig. 1 Ueda classification of hepatocellular carcinoma with bile duct tumor thrombi classified according to thrombus location [7].

• 

  Fig. 2 Actuarial survival curve after hemihepatectomy for hepatocellular carcinoma with grossly bile duct invasion (n = 20).

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  Fig. 3 (A) Actuarial survival curves of hemihepatectomy with thrombectomy group (light line) and hemihepatectomy with extrahepatic bile duct (BD) resection (deep line) (P = 0.014). (B) Actuarial recurrence free survival curves of hemihepatectomy with thrombectomy group (light line) and hemihepatectomy with extrahepatic BD resection (deep line) (P = 0.023).

• 

  Fig. 4 The description of recurrent sites for 15 recurrence cases.

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  Fig. 5 (A) One bile duct tumor thrombi (BDTT) case with a skipped bile duct (BD) invasion. Some fine fibrous tissues with minute oozing without any residual tumor thrombi. (B) One BDTT case with a skipped BD invasion. Some fine fibrous tissues with minute oozing without any residual tumor thrombi. (C) Histologic examination of the fibrous bridge structure. A focus of skipped tumor invasion (left: H&E, ×100; right: H&E, ×400). BDE, bile duct epithelium.

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