MATERIALS AND METHODS
Population and clinical features
From 2001 to 2015, a total of 407 HCC patients underwent hepatic resection at the Hepatobiliary and Pancreas Unit, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand. We reviewed the medical records of these 19 patients, and 4.7% were found to have v. The patients’ consent to review the medical record was requested, and all patient consents were received. The Faculty of Medicine, Chiang Mai University Institutional Review Board, approved the study. Fifteen patients were male and four were female with the mean age of 51.1±11.5 years (range 35–76 years). The diagnosis of HCC with BDTT was made from the histopathological examination of the tumor thrombi in the 16 patients who had undergone curative hepatic resection (Figure 1) and two patients who had undergone palliative choledochotomy to remove BDTT with a biliary drainage procedure. Nonsurgical treatment was performed only in one patient who was initially diagnosed with HCC and BDTT from computed tomography (CT) of the abdomen (Figure 2), concurrent with the evidence of an elevated serum alpha-fetoprotein (AFP) level >950 IU/mL.
Chronic hepatitis B virus (HBV) infection plays an important role in HCC development in our patients and was present in 16 (84.2%) patients. Six patients received antiviral medication before surgery, and the remaining were treated after surgery. Two hepatitis C virus (HCV)-infected patients could not be treated with anti-HCV medication because of their health insurance coverage. The pathologically proven presence of cirrhosis was found in 12 (63.2%) patients. Serum AFP >20 ng/mL was present in 15 (78.9%) patients. The remaining patients had only epigastric pain (n = 3), right upper quadrant mass (n = 1), or were asymptomatic (n = 1). One patient had a history of preoperative transcatheter arterial chemoembolization (TACE) because initially he refused surgical treatment. The clinical and laboratory features of all 19 patients are shown in Table 1.