Abstract
Background. The aim of this study was to clarify clinicopathologic characteristics of, and to
evaluate an aggressive treatment strategy for, hepatocellular carcinoma with biliary
tumor thrombi. Methods. From 1980 to 1999, a total of 132 patients underwent hepatectomy for hepatocellular
carcinoma. Of these, 17 patients had macroscopic biliary tumor thrombi and were retrospectively
analyzed. Results. The operative procedures included right hepatic trisegmentectomy (n = 1), right or
left hepatic lobectomy (n = 11), and segmentectomy or subsegmentectomy (n = 5). In
13 patients, tumor thrombi extended beyond the hepatic confluence and was treated
by thrombectomy through a choledochotomy in 8 patients and extrahepatic bile duct
resection and reconstruction in 5 patients. The 3- and 5-year survival rates were
47% and 28%, respectively, with a median survival time of 2.3 years. These survival
rates were similar to those achieved in 115 patients without biliary tumor thrombi.
In a multivariate 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 hepatocellular carcinoma with
biliary tumor thrombi yields results similar to those of patients without biliary
involvement. Hepatectomy with thrombectomy through a choledochotomy appears to be
as effective as a resection procedure. (Surgery 2001;129:692-8.)
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Article info
Publication history
Accepted:
December 31,
2000
Footnotes
*Reprint requests: Yuji Nimura, MD, Professor and Chairman, First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
**Surgery 2001;129:692-8
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
