• Annals of surgery · May 2020

    Multicenter Study

    Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus: A Korea-Japan Multicenter Study.

    • Dong-Sik Kim, Bong-Wan Kim, Etsuro Hatano, Shin Hwang, Kiyoshi Hasegawa, Atsushi Kudo, Shunichi Ariizumi, Masaki Kaibori, Takumi Fukumoto, Hideo Baba, Seong Hoon Kim, Shoji Kubo, Kim Jong Man JM Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea., Keun Soo Ahn, Sae Byeol Choi, Chi-Young Jeong, Yasuo Shima, Hiroaki Nagano, Osamu Yamasaki, Hee Chul Yu, Dai Hoon Han, Hyung-Il Seo, Il-Young Park, Kyung-Sook Yang, Masakazu Yamamoto, and Hee-Jung Wang.
    • Department of Surgery, Korea University College of Medicine, Seoul, Korea.
    • Ann. Surg. 2020 May 1; 271 (5): 913-921.

    ObjectiveTo identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT).Summary Background DataPrognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports.MethodsRecords of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model.ResultsCurative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P < 0.001) and the presence of fibrosis/cirrhosis (P = 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99); P = 0.044 and HR = 0.51 (0.31-0.84); P = 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91); P = 0.018 and HR = 0.61 (0.42-0.89); P = 0.009, respectively].ConclusionsClinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.

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