Background: Obstructive jaundice caused due to bile duct tumor thrombus (BDTT) in a hepatocellular carcinoma (HCC) patient is an uncommon event. This study reports our clinical experiences and evaluates the outcomes of HCC patients with BDTT in a single institution.
Methods: A retrospective review of 19 HCC patients with secondary obstructive jaundice caused due to BDTT during a 15-year period was conducted.
Results: At the time of diagnosis, 14 (73.7%) patients had obstructive jaundice. Eighteen (94.7%) patients were preoperatively suspected of “obstruction of the bile duct”. Sixteen patients (84.2%) underwent a hepatectomy with curative intent, while two patients underwent removal of BDTT combined with biliary decompression and another patient received only palliative care as his liver reserve and general condition could not tolerate the primary tumor resection. The overall early recurrence (within 1 year) after hepatectomy occurred in more than half (9/16, 56.3%) of our patients. The 1-year survival rate of patients was 75% (12/16). The longest disease-free survival time was >11 years.
Conclusion: Identification of HCC patients with obstructive jaundice is clinically important because proper treatment can offer an opportunity for a cure and favorable long-term survival.


Keywords: hepatocellular carcinoma, biliary thrombosis, hepatectomy, recurrence, survival  


INTRODUCTION

Obstructive jaundice caused due to bile duct tumor thrombus (BDTT) is an uncommon event in a hepatocellular carcinoma (HCC) patient. The incidence ranges from 1% to 12.9% in autopsy and surgical specimens.1–6 Few published reports exist regarding HCC with obstructive jaundice caused due to BDTT, and these patients are often misdiagnosed as having cholangiocarcinoma (CCA) or choledocholithiasis.3,7 Improvement of diagnosis imaging and more awareness regarding the recognition of this type of disease will increase the incidence of a correct preoperative diagnosis and further effective treatment planning.1–3,8–11 Thailand has a high incidence of HCC and liver cirrhosis.12In this study, we summarize our clinical experiences and evaluate the results of different treatment modalities of 19 cases of this type of HCC during the past 15 years in a single high-volume institution in the north of Thailand.