Surgical treatment of hepatocellular carcinoma with biliary tumor thrombi.

Treatment is always abandoned in those HCC with jaundice, because it is usually attributed to the underlying liver cirrhosis and extensive tumor. In this series, 7 cases (0.8%) of HCC with jaundice were caused by bile duct invasion and tumor thrombi (BTT). 57% of cases showed Charcot's triad. 57% of BTT were small HCC, significantly higher than the 1.7% of total cases (p<0.05). The growth pattern of BTT was all spreading type, significantly higher than the 42% of total operation cases (p<0.05). The DNA ploidy of BTT was all aneuploid. 57% of BTT had AFP level higher than 400 IU/ml, but it was 27% in total cases. The prognosis is poor in those treated with palliative tube drainage. Aggressive hepatic resection was proved to be safe and achieved the best results in our limited experience. Choledochotomy to remove tumor thrombi is contraindicated because it easily causes tumor seeding. It is advocated to search BTT for resection from the group of HCC with jaundice.