A LOGICAL APPROACH TO HEPATOCELLULAR-CARCINOMA PRESENTING WITH JAUNDICE

Objective This prospective cohort study on patients with hepatocellula r carcinoma (HCC) presenting with jaundice emphasized the importance o f differentiating patients with hepatic insufficiency from patients wi th obstructive jaundice caused by tumor. Summary Background Data There are little data in the medical literature on the management of patien ts with HCC presenting with jaundice. Experience has accumulated mainl y from case reports and retrospective studies. Methods Data were colle cted prospectively on 2095 patients with HCC seen over a 12-year perio d. All patients were investigated with blood tests, abdominal ultrasou nd, and chest radiography. Endoscopic retrograde cholangiopancreatogra phy-percutaneous transhepatic cholangiography, computed tomography and hepatic angiography were carried out in selected patients. Results Of the 530 patients who had clinically detectable jaundice, 481 had jaun dice due to hepatic insufficiency and 49 patients had obstructive jaun dice. Patients with hepatic insufficiency had extremely poor prognosis , and 90% of them died within 10 weeks of first presentation. ''Curati ve'' resection, however, was possible in 9 of 49 patients with obstruc tive jaundice, and histologic analysis showed resectional margin invol vement by tumor in 1 patient. In addition, 35 patients were treated wi th biliary stents to relieve the obstructive jaundice. Supportive trea tment only was given to five patients who were considered too terminal ly ill. The overall survival of patients with HCC with obstructive jau ndice was similar to those patients who presented with no clinical det ectable jaundice and was much better than those with jaundice due to h epatic insufficiency (log-rank test, p < 0.001). Conclusions The progn osis of patients with HCC who presented with jaundice due to hepatic i nsufficiency was dismal. It is important to identify the patients who had obstructive jaundice because with proper treatment, good palliatio n and occasional cure are possible.