Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Associate Professor
Article types Original article
Language English
Peer review Peer reviewed
Title Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus: A Korea-Japan Multicenter Study.
Journal Formal name:Annals of surgery
Abbreviation:Ann Surg
ISSN code:15281140/00034932
Volume, Issue, Page 271(5),pp.913-921
Author and coauthor Kim Dong-Sik, Kim Bong-Wan, Hatano Etsuro, Hwang Shin, Hasegawa Kiyoshi, Kudo Atsushi, Ariizumi Shunichi, Kaibori Masaki, Fukumoto Takumi, Baba Hideo, Kim Seong Hoon, Kubo Shoji, Kim Jong Man, Ahn Keun Soo, Choi Sae Byeol, Jeong Chi-Young, Shima Yasuo, Nagano Hiroaki, Yamasaki Osamu, Yu Hee Chul, Han Dai Hoon, Seo Hyung-Il, Park Il-Young, Yang Kyung-Sook, Yamamoto Masakazu, Wang Hee-Jung
Publication date 2020/05
Summary OBJECTIVE:To 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 DATA:Prognoses 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.METHODS:Records 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.RESULTS:Curative 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].CONCLUSIONS:Clinical 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.
DOI 10.1097/SLA.0000000000003014
PMID 30216223