Thrombus-First Surgery for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus
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ORIGINAL ARTICLE
Thrombus-First Surgery for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus Juxian Sun 1 & Jiayi Wu 2 & Jie Shi 1 & Chang Liu 1 & Yonggang Wei 3 & Jianyin Zhou 4 & Zhibo Zhang 5 & Maolin Yan 2 & Shuqun Cheng 1 Received: 11 May 2020 / Accepted: 29 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Objective The optimal surgical method of patients with hepatocellular carcinoma (HCC) and bile duct tumor thrombus (BDTT) is still controversial. This study aims to investigate the impact of different surgical methods on BDTT patients. Methods A multicenter retrospective study was carried out on HCC patients with BDTT who underwent surgery. The survival outcomes of different operation methods were studied. Results A total of 120 HCC patients with BDTT from 5 different clinical centers were included. The median disease-free survival (DFS) of the bile duct resection (BDR) group was significantly better than that of the non-BDR group (24.6 months vs. 18.9 months, p = 0.034), but the overall survival (OS) was similar between the two groups (33.6 months vs. 32.3 months, p = 0.193). When we divided the non-BDR group into two groups according to the operation sequence of the hepatic tumor and BDTT, we found that the OS of the thrombus-first group was significantly longer than that of the tumor-first group (42.7 months vs. 23.6 months, p = 0.016). When compared with the BDR group, the thrombus-first group showed similar OS (42.7 months vs. 33.6 months, p = 0.653) and DFS (24.7 months vs. 24.6 months, p = 0.150), which may be the reason the OS rate of the BDR group was similar to that of the non-BDR group. Conclusions A thrombus-first technique could be considered for HCC patients with extrahepatic BDTT, especially for those patients in which the tumor thrombus did not invade the bile duct. Keywords Hepatocellular carcinoma . Bile duct tumor thrombus . Surgery . Obstructive jaundice
Introduction Juxian Sun, Jiayi Wu and Jie Shi contributed equally to this work. * Maolin Yan [email protected] * Shuqun Cheng [email protected] 1
Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai 200433, China
2
Department of Hepatobiliary Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian, China
3
Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China
4
Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China
5
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
Hepatocellular carcinoma (HCC) is the fifth most common neoplasm and the third leading cause of cancer-related mortality worldwide1. Bile duct tumor thrombus (BDTT) is an important and well-known clinical feature of HCC, but its incidence is only 1–9%2–4, and the mechanism is still unclear. Most BDTT patients are hospitalized for
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