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Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus

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Author(s)
Dong-Sik KimBong-Wan KimEtsuro HatanoShin HwangKiyoshi HasegawaAtsushi KudoShunichi AriizumiMasaki KaiboriTakumi FukumotoHideo BabaSeong Hoon KimShoji KuboJong Man KimKeun Soo AhnSae Byeol ChoiChi-Young JeongYasuo ShimaHiroaki NaganoOsamu YamasakiHee Chul YuDai Hoon HanHyung-Il SeoIl-Young ParkKyung-Sook YangMasakazu YamamotoHee-Jung Wang
Keimyung Author(s)
Ahn, Keun Soo
Department
Dept. of Surgery (외과학)
Journal Title
Annals of Surgery
Issued Date
2018
Keyword
bile duct resectionjaundiceliver resectionprognosis, survivalthrombectomy
Abstract
Objective:
To identify optimal surgical methods and the risk factors for longterm 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 ¼ 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 ¼ 0.61 (0.38-0.99); P ¼ 0.044 and HR ¼ 0.51 (0.31-0.84); P ¼ 0.008, respectively] and decreased recurrence rate [HR ¼ 0.59 (0.38-0.91); P ¼ 0.018 and HR ¼ 0.61 (0.42-0.89); P ¼ 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.
Keimyung Author(s)(Kor)
안근수
Publisher
School of Medicine (의과대학)
Citation
Dong-Sik Kim et al. (2018). Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus. Annals of Surgery. doi: 10.1097/SLA.0000000000003014
Type
Article
ISSN
0003-4932/
Source
https://insights.ovid.com/pubmed?pmid=30216223
DOI
10.1097/SLA.0000000000003014
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41776
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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