Title: Hepatocellular Carcinoma with Bile Duct Tumor Thrombi (Icteric Hepatoma)– A 19 Year Experience from a Tertiary Care Centre

Authors: Dr K. Sathish Kumar, Dr S.Jeswanth, Dr P. Ravichandran, Dr C. Sugumar,  Dr R. Prabhakaran, Dr P. Senthil Kumar, Dr R.Kamalakannan

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.76

Abstract

Introduction/Objective: Hepatocellular carcinoma presenting with obstructive jaundice due to bile duct tumor thrombi is a rare entity, with a reported incidence worldwide of about 1 to 12 %. The objective of this study is to analyse the clinicopathological and post-surgical outcomes in patients who had hepatocellular carcinoma with bile duct tumor thrombi.

Materials and Methods: 42 cases of pathologically proven Hepatocellular carcinoma with bile duct tumor thrombi in non-cirrhotic liver, who underwent hepatectomies at Institute of Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College and hospital, between January 1997 and September 2016 were analysed retrospectively. Clinicopathological, biochemical, radiological, operative variables and post-operative morbidity and mortality were analysed.

Results: Pre-operative AFP were elevated in 28 patients (> 400 ng/ml). Right hepatectomy with thrombectomy and T tube drainage, extended right hepatectomy with bile duct excision, left hepatectomy, extended left hepatectomy with bile duct excision, left lateral segmentectomy were done in 17,11,10,2 and 2 patients respectively. 14 patients had significant post-operative morbidity while mortality was seen in three patients. Median survival was about 27.2 months. Tumor recurrence was observed in 28 of 42 cases (66.67%) with a median time to recurrence of about 10.3 months.

Conclusion: Bile duct tumor thrombi does not preclude hepatic resection and these patients who are otherwise fit to undergo hepatectomy are offered surgery as the first line treatment.

Keywords – hepato cellular carcinoma, obstructive jaundice, bile duct tumor thrombi.

References

  1. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362:1907–17
  2. Kojiro M, Kawabata K, Kawano Y, Shirai F, Takemoto N, Nakashima T. Hepatocellular carcinoma presenting as intrabile duct tumor growth: a clinicopathologic study of 24 cases. Cancer. 1982;49:2144–7.
  3. Huang JF, Wang LY, Lin ZY, Chen SC, Hsieh MY, Chuang WL, et al. Incidence and clinical outcome of icteric type hepatocellular carcinoma. J Gastroenterol Hepatol. 2002;17:190–5.
  4. Satoh S, Ikai I, Honda G, Okabe H, Takeyama O, Yamamoto Y, et al.Clinicopathologic evaluation of hepatocellular carcinoma with bile duct thrombi. Surgery. 2000;128:779–83.
  5. Shiomi M, Kamiya J, Nagino M, Uesaka K, Sano T, Hayakawa N, et al. Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management. Surgery. 2001;129:692–8.
  6. Peng SY, Wang JW, Liu YB, Cai XJ, Xu B, Deng GL, et al. Hepato cellular carcinoma with bile duct thrombi: analysis of surgical treatment. Hepatogastroe-nterology. 2004;51:801–4.
  7. Qin LX, Ma ZC, Wu ZQ, Fan J, Zhou XD, Sun HC, et al. Diagnosis and surgical treatments of hepatocellular carcinoma with tumor thrombosis in bile duct: experience of 34 patients. World J Gastroenterol. 2004;10:1397–401.
  8. Yeh CN, Jan YY, Lee WC, Chen MF. Hepatic resection for hepatocellular carcinoma with obstructive jaundice due to biliary tumor thrombi. World JSurg. 2004;28:471–5.
  9. Ueda M, Takeuchi T, Takayasu T, Takahashi K, Okamoto S, Tanaka A. Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi. Hepatogastroenterology 1994; 41: 349-354
  10. Mallory TB, Castleman B, Parris EE. Case records of the Massachusetts General Hospital. N Eng J Med 1947; 237: 673-676
  11. Oba A, Takahashi S, Kato Y, Gotohda N, Kinoshita T, Shibasaki H, et al.Usefulness of resection for hepatocellular carcinoma with macroscopic bileduct tumor throm-bus. Anticancer Res. 2014;34:4367–72.
  12. Xiangji L, Weifeng T, Bin Y, Chen L, Xiaoqing J, Baihe Z, et al. Surgery of hepatocellular carcinoma complicated with cancer thrombi in bile duct:
  13. Shiomi M, Kamiya J, Nagino M, Uesaka K, Sano T, Hayakawa N,et al. Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management. Surgery 2001;129:692-698.
  14. Moon DB, Hwang S, Wang HJ, Yun SS, Kim KS, Lee YJ, Kim KH, Park YK Surgical Outcomes of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Korean Multicenter Study. World J Surg 2013; 37:443–451
  15. Yeh CN, Jan YY, Lee WC, Chen MF: Hepatic resection for hepatocellular carcinoma with obstructive jaundice due to biliary tumor thrombi. World J Surg 2004;28:471-475.
  16. Y, Hatano E, Seo S, Taura K, Yasuchika K, Uemoto S. Hepatocellular carcinoma with bile duct tumor thrombus: surgical outcomes and the prognostic impact of concomitant majorvascular invasion. World J Surg 2015;39:1485-1493
  17. Ikenaga N, Chijiiwa K, Otani K, Ohuchida J, Uchiyama S,Kondo K. Clinicopa-thologic characteristics of hepatocellular carcinoma with bile duct invasion. J GastrointestSurg 2009;13:492-497.
  18. Zeng H, Xu LB, Wen JM, Zhang R, Zhu MS, Shi XD, et al. Hepatocellular carcinoma with bile duct tumor thrombus: a Clinicopathological analysis of factors predictive of recurrence andoutcome after surgery. Medicine (Baltimore) 2015; 94:e364
  19. Xiangji L, Weifeng T, Bin Y, Chen L, Xiaoqing J, Baihe Z, etal. Surgery of hepatocellular carcinoma complicated with cancerthrombi in bile duct: efficacy for criteria for different the rapymodalities. Langenbecks Arch Surg 2009;394:1033-1039
  20. Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J. Different risk factors andpro-gnosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer. 2000;89:500–7.
  21. Noda T, Nagano H, Tomimaru Y, Murakami M, Wada H, Kobayashi S, et al.Prognosis of hepatocellular carcinoma with biliary tumor thrombi after liversurgery. Surgery. 2011;149:371–7
  22. Shao W, Sui C, Liu Z, Yang J, Zhou Y. Surgical outcome of hepatocellular carcinoma patients with biliary tumor thrombi. World J Surg Oncol. 2011;9:2
  23. Yamamoto S, Hasegawa K, Inoue Y, Shindoh J, Aoki T, Sakamoto Y, et al. Bileduct preserving surgery for hepatoce-llular carcinoma with bile duct tumorthr-ombus. Ann Surg. 2015;261:e123–5
  24. Wong TC, Cheung TT, Chok KS, Chan AC, Dai WC, Chan SC, et al. Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumourthrombus. HPB (Oxford). 2015;17:401–8.
  25. Ha TY, Hwang S, Moon DB, Ahn CS, Kim KH, Song GW, et al. Long-termsurvival analysis of liver transplantation for hepatocellular carcinoma withbile duct tumor thrombus. Transplant Proc. 2014;46:774–7.

Corresponding Author

Dr K. Sathish Kumar

Resident, Institute of Surgical Gastroenterology and Liver Transplant,

Government Stanley Medical College and Hospital, Chennai