Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus: A Korea-Japan Multicenter Study

Dong Sik Kim, Bong Wan Kim, Etsuro Hatano, Shin Hwang, Kiyoshi Hasegawa, Atsushi Kudo, Shunichi Ariizumi, Masaki Kaibori, Takumi Fukumoto, Hideo Baba, Seong Hoon Kim, Shoji Kubo, Jong Man Kim, Keun Soo Ahn, Sae Byeol Choi, Chi Young Jeong, Yasuo Shima, Hiroaki Nagano, Osamu Yamasaki, Hee Chul YuDai Hoon Han, Hyung Il Seo, Il Young Park, Kyung Sook Yang, Masakazu Yamamoto, Hee Jung Wang

    Research output: Contribution to journalArticlepeer-review

    40 Citations (Scopus)


    Objective:To identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT).Summary Background Data:Prognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports.Methods:Records of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model.Results:Curative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P < 0.001) and the presence of fibrosis/cirrhosis (P = 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99); P = 0.044 and HR = 0.51 (0.31-0.84); P = 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91); P = 0.018 and HR = 0.61 (0.42-0.89); P = 0.009, respectively].Conclusions:Clinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.

    Original languageEnglish
    Pages (from-to)913-921
    Number of pages9
    JournalAnnals of surgery
    Issue number5
    Publication statusPublished - 2020 May 1

    Bibliographical note

    Publisher Copyright:
    © 2020 Lippincott Williams and Wilkins. All rights reserved.


    • bile duct resection
    • jaundice
    • liver resection
    • prognosis
    • survival
    • thrombectomy

    ASJC Scopus subject areas

    • Surgery


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