Orimo Tatsuya, Kamiyama Toshiya, Yokoo Hideki, Wakayama Kenji, Shimada Shingo, Tsuruga Yosuke, Kamachi Hirofumi, Taketomi Akinobu
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Ann Surg Oncol. 2016 Aug;23(8):2627-34. doi: 10.1245/s10434-016-5174-7. Epub 2016 Mar 22.
This study aimed to evaluate the short- and long-term outcomes of hepatectomy for hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT), including cases with obstructive jaundice.
The study reviewed 42 HCC patients with BDTT, including six patients who needed preoperative biliary drainage due to obstructive jaundice, and 732 HCC patients without BDTT. The authors analyzed the impact of BDTT on the surgical outcomes and assessed the outcomes of hepatectomy for patients presenting with obstructive jaundice.
The HCC patients with BDTT, almost all with stage 3 or 4 disease, had increased alpha-fetoprotein expression, larger tumors, and more portal vein invasion status. The survival of the HCC patients with BDTT was significantly inferior to that of the patients without BDTT (p = 0.0003). Survival did not differ significantly between the HCC patients with BDTT and those without BDTT when the two groups were matched by stage (p = 0.3366). The HCC patients with BDTT who presented with obstructive jaundice demonstrated outcomes similar to those for the HCC patients with BDTT who did not present with obstructive jaundice in terms of the overall survival rate (p = 0.5469). The perioperative outcomes for the HCC patients with BDTT did not depend on the presence or absence of preoperative jaundice. No patients in either BDTT group demonstrated 90-day mortality in this study.
Hepatectomy should be considered for HCC patients with BDTT, even for patients with obstructive jaundice, because the surgical outcomes equivalent to those for HCC without BDTT can be achieved.
本研究旨在评估肝细胞癌（HCC）合并胆管癌栓（BDTT）患者肝切除的短期和长期预后，包括合并梗阻性黄疸的病例。
本研究回顾了42例合并BDTT的HCC患者，其中6例因梗阻性黄疸需要术前胆道引流，以及732例未合并BDTT的HCC患者。作者分析了BDTT对手术结局的影响，并评估了合并梗阻性黄疸患者肝切除的结局。
合并BDTT的HCC患者几乎均为3或4期疾病，甲胎蛋白表达升高、肿瘤更大且门静脉侵犯情况更多。合并BDTT的HCC患者的生存率显著低于未合并BDTT的患者（p = 0.0003）。按分期匹配两组时，合并BDTT的HCC患者与未合并BDTT的患者之间生存率无显著差异（p = 0.3366）。合并梗阻性黄疸的BDTT患者与未合并梗阻性黄疸的BDTT患者相比，总生存率方面的结局相似（p = 0.5469）。合并BDTT的HCC患者围手术期结局不取决于术前黄疸的有无。本研究中BDTT组患者均未出现90天死亡率。
合并BDTT的HCC患者，即使是合并梗阻性黄疸的患者，也应考虑行肝切除，因为可以获得与未合并BDTT的HCC患者相当的手术结局。
