Obstructive jaundice caused by tumor emboli from hepatocellular carcinoma

Hepatocellular carcinoma (HCC) presenting as obstructive jaundice due to in trabile duct tumor growth is being reported with increasing frequency. We d escribe our clinical experiences and evaluate the results of different oper ative procedures for this disease. A retrospective study was undertaken to review 18 patients with obstructive jaundice by tumor emboli from HCC durin g a 15-year period of time. We reviewed clinical features, types of operati ve procedures, operative findings, and survival in the patients. All patien ts on initial examination had recurrent episodic jaundice or cholangitis. T ypes of surgical procedures were choledochotomy with T-tube drainage alone in nine patients, choledochotomy with T-tube drainage followed by hepatecto my in six, and T-tube drainage followed by transcatheter hepatic arterial c hemoembolization in the remaining three patients. Liver cirrhosis was the a ssociated disease in 15 (83.3%). There were three postoperative deaths (16. 7%). The mean survival time for nine patients with external drainage alone was 4.5 months. For the three patients with T-tube drainage and transcathet er hepatic arterial chemoembolization, mean survival time was 11 months. Si x patients who had undergone hepatectomy had a better postoperative surviva l time, with 1 surviving for more than 3 years and another alive for 70 mon ths, without evidence of recurrence at the moment. Jaundice is not necessar ily a harbinger of advanced disease and a contraindication for surgery. Man aged properly, these patients will have satisfactory palliation and occasio nal cure.