M. Shiomi et al., Hepatocellular carcinoma with biliary tumor thrombi: Aggressive operative approach after appropriate preoperative management, SURGERY, 129(6), 2001, pp. 692-698
Background. The aim of this study was to clarify clinicopathologic characte
ristics of and to evaluate an aggressive treatment strategy for hepatocellu
lar carcinoma with biliary tumor thrombi.
Methods. From 1980 to 1999 a total of 132 patients underwent hepatectomy fo
r hepatocellular carcinoma. Of these, 17 patients had macroscopic biliary t
umor thrombi and were retrospectively analyzed.
Results. The operative procedures included right hepatic trisegmentectomy (
n = 1), light or left hepatic lobectomy (n = 11), and segmentectomy or subs
egmentectomy (n = 5). In 13 patients, tumor thrombi extended beyond the hep
atic confluence and was treated by thrombectomy through a choledochotomy in
8 patients and extrahepatic bile duct resection and reconstruction in 5 pa
tients. The 3- and 5-year survival rates were 47% and 28%, respectively, wi
th a median survival time of 2.3 yews. These survival rates were similar to
those achieved in 115 patients without biliary tumor thrombi. In a multiva
riate 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 hepatocel
lular carcinoma with biliary tumor thrombi yields results similar to those
of patients without biliary involvement. Hepatectomy with thrombectomy thro
ugh a choledochotomy appears to be as effective as a resection procedure.