OBSTRUCTIVE-JAUNDICE SECONDARY TO HEPATOCELLULAR-CARCINOMA

This prospective study aimed to identify different groups of patients with the rare pathology of biliary obstruction caused by hepatocellula r carcinoma (HCC). Patients were evaluated with blood tests, chest rad iography, ultrasound of the liver and endoscopic retrograde cholangiop ancreatography/percutaneous transhepatic cholangiography. Patients who were potentially operable were further assessed with selective hepati c angiography and computed tomography (CT). Of the 38 patients with ob structive jaundice secondary to HCC, the levels of obstruction were ex trahepatic in 19 patients and intrahepatic in 19 patients. The clinica l presentations and blood biochemistry were similar in these two group s of patients. 'Curative' resection was significantly more common in e xtrahepatic obstruction (8/19) than in intrahepatic obstruction (0/19) (chi(2) with Yates correction P=0.001). All non-resectable tumours, e xcept in four patients with terminally ill disease, were palliated wit h stents. Survival in patients who had 'curative' liver resection was significantly better than in those who had no resection (median surviv al 25.3 vs. 2.1 months, log-rank test P=0.004). Patients with extrahep atic biliary obstruction secondary to HCC had a better chance of being treated by liver resection, which resulted in a significantly improve d survival rate compared to patients with intrahepatic obstruction.