Surgical Outcomes of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Korean Multicenter Study

作者：Deok‐Bog Moon, Shin Hwang, H.-J. Wang, Sung‐Su Yun, Kyung Sik Kim, Young Joo Lee, Ki‐Hun Kim, Yong‐Keun Park, Weiguang Xu, Bong‐Wan Kim, Dong Shik Lee, Donghyun Lee, Hong‐Jin Kim, Jin Hong Lim, Jin Sub Choi, Yo‐Han Park, Sung‐Gyu Lee · 发表于：World Journal of Surgery · 年份：2012 · DOI：10.1007/s00268-012-1845-0 · 被引用次数：75 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Cholangiocarcinoma and Gallbladder Cancer Studies、Cancer Research and Treatment

BACKGROUND: The long-term outcomes after resection for hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT) are unclear. This multicenter study was conducted to determine the prognosis of HCC patients with macroscopic BDTT who underwent resection with curative intent. METHODS: Of 4,308 patients with HCC from four Korean institutions, this single-arm retrospective study included 73 patients (1.7 %) who underwent resection for HCC with BDTT. RESULTS: Jaundice was also present in 34 patients (46.6 %). According to Ueda classification, BDTT was type 2 in 34 cases (46.6 %) and type 3 in 39 cases (53.4 %). Biliary decompression was performed in 33 patients (45.2 %), decreasing the median lowest bilirubin level to 1.4 mg/dL before surgery. Systematic hepatectomy was performed in 69 patients (94.5 %), and concurrent bile duct resection was performed in 31 patients (42.5 %). Surgical curability types were R0 (n = 57; 78.1 %), R1 (n = 11; 15.1 %), and R2 (n = 5; 6.8 %). Patient survival rates were 76.5 % at 1 year, 41.4 % at 3 years, 32.0 % at 5 years, and 17.0 % at 10 years. Recurrence rates were 42.9 % at 1 year, 70.6 % at 3 years, 77.3 % at 5 years, and 81.1 % at 10 years. Results of univariate survival analysis showed that maximal tumor size, bile duct resection, and surgical curability were significant risk factors for survival, and surgical curability was a significant risk factor for recurrence. Multivariate analysis did not reveal any independent risk...