Dong-Sik Kim1, Bong-Wan Kim2, Etsuro Hatano3, Shin Hwang4, Kiyoshi Hasegawa5, Atsushi Kudo6, Shunichi Ariizumi7, Masaki Kaibori8, Takumi Fukumoto9, Hideo Baba10, Seong Hoon Kim11, Shoji Kubo12, Jong Man Kim13, Keun Soo Ahn14, Sae Byeol Choi1, Chi-Young Jeong15, Yasuo Shima16, Hiroaki Nagano17, Osamu Yamasaki18, Hee Chul Yu19, Dai Hoon Han20, Hyung-Il Seo21, Il-Young Park22, Kyung-Sook Yang23, Masakazu Yamamoto7, Hee-Jung Wang2. 1. Department of Surgery, Korea University College of Medicine, Seoul, Korea. 2. Department of Surgery, Ajou University School of Medicine, Suwon, Korea. 3. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 5. Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 6. Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 7. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 8. Department of Surgery, Hirakata Hospital Kansai Medical University, Osaka, Japan. 9. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 10. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Life Sciences, Kumamoto, Japan. 11. Center for liver cancer, National Cancer Center, Ilsan, Korea. 12. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 13. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 14. Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. 15. Department of Surgery, Gyeongsang National University, College of Medicine, Jinju, Korea. 16. Department of Gastroenterological Surgery, Kochi Health Sciences Center, Koichi, Japan. 17. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. 18. Department of Surgery, Osaka City Juso Hospital, Osaka, Japan. 19. Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea. 20. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 21. Department of Surgery, Pusan National University College of Medicine, Busan, Korea. 22. Department of Surgery, Bucheon St. Mary Hospital, Catholic Univerity of Korea, Bucheon, Korea. 23. Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Abstract
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.
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.