Surgical Management for Hepatocellular Carcinoma with Obstructive Jaundice

ABSTRACT

PURPOSE: The aim of this study was to evaluate the result of aggressive surgical treatment for hepatocellular carcinomas with obstructive jaundice due to intrabiliary tumor growth or migration of tumor fragments to the distal bile duct. METHODS: Between 1998 and 2002, 417 patients underwent a hepatectomy for a hepatocellular carcinoma, and 8 with obstructive jaundice, as a result of intrabiliary tumor growth or biliary tumor embolus, were retrospectively analyzed. RESULTS: The intrabiliary tumor growth of the hepatocellular carcinoma extended beyond the hepatic confluence in 5 patients, and lay within the intrahepatic duct in 1. All other patients had tumor fragments from the hepatocellular carcinoma in the common bile duct. Vascular invasion was discovered preoperatively, with the use of computed tomography, in 1 patient. Preoperative percutaneous transhepatic biliary drainage was performed in 7 patients, and 5 underwent transarterial chemoembolization. Shrinkage of the tumor fragments into the intrahepatic duct was shown in only 1 patient. The operative procedures included a hepatectomy (n=2), a hepatectomy with embolectomy through choledochotomy (n=2) and a hepatectomy with resection and reconstruction of the common bile duct (n=4). The curative resection and 3-year survival rates, and the median survival time were 62.5 and 43.8%, and 20.6 months, respectively. CONCLUSION: In an advanced hepatocellular carcinoma with intrabiliary tumor growth or biliary tumor embolus, an aggressive surgical approach, with accurate assessment of the anatomical resectability and appropriate preoperative management, can increase the curative resection and survival rates.