Key Word(s): 1. bowel obstruction; 2. diagnosis; 3. biomarkers; 4. physical examination; Presenting Author: JOHNSON MARIAANTONY Corresponding Author: JOHNSON MARIAANTONY Affiliations: Dr.
www.selleckchem.com/products/lee011.html MGR Medical Unversity Objective: Obstructive jaundice due to Bile Duct Tumor Thrombi is an uncommon presenting feature of Hepatocellular Carcinoma (HCC) reported in about 2–9% (Okuda &Nakashima series) and 12% (Hong Kong study group) of cases respectively. Only a few studies have examined the outcome of hepatectomy in this subset of patients. Aim: To evaluate the outcome of hepatectomy for non- fibrolamellar- type HCC with obstructive jaundice due to bile duct tumor thrombi in non-cirrhotic liver. Methods: From 1995 to 2007, out of 156 HCC patients, 19 (12.1%) with
non-fibrolmellar- type HCC with obstructive jaundice due to bile duct tumor thrombi in non-cirrhotic BMS-354825 datasheet liver, who underwent hepatectomy were retrospectively analyzed. HBsAg, Anti HCV Ab and AFP were positive in 3 (15.7%), one (5.2%), and 13 (68.4%) cases respectively. The operative procedures included, right hepatectomy with thrombectomy through choledochotomy and T-tube drainage (n = 8), extended right hepatectomy combined with extrahepatic bile duct excision (n = 3), left hepatectomy (n = 6), extended left hepatectomy (n = 1) and left lateral segmentectomy (n = 1). Results: The diameter of primary Non-specific serine/threonine protein kinase tumor ranged from 5 to 13 cm. Biliary tumor thrombi were located in the right and left hepatic ducts in two, free floating in the common bile duct in 9, and extended across the confluence of the right and left hepatic ducts in 8 patients respectively according to Satoh’s classification. Portal vein invasion were found in 4 patients (right branch n = 1, left branch n = 1, right posterior branch n = 1, right branch to stem n = 1). Postoperative morbidity was 31.5% (n = 6), which included bile leak in 4 (21.05%) patients. One patient died of postoperative liver failure (mortality rate 5.2%). The tumor recurrence rates were intrahepatic in 68.4%, extrahepatic in 21.0% and both intrahepatic and extrahepatic in
10.5%. The 1-; 3- and 5-year survival rates were 78.9%, 47.3% and 10.5% respectively with a median survival time of 24.8 months. Conclusion: Presence of bile duct tumor thrombi in HCC patients should not be considered as advanced disease or inoperable lesion. When technically feasible, a formal hepatic resection is the first-line treatment option in a subset of HCC patients with obstructive jaundice due to bile duct tumor thrombi in non-cirrhotic liver with significantly large-sized tumors. It can achieve better quality of life with significant improvement in both disease-free and overall survival. Key Word(s): 1. HCC; 2. Non-cirrhotic liver; 3. Tumor thrombi; 4. Hepa; Presenting Author: JOHNSON MARIAANTONY Corresponding Author: JOHNSON MARIAANTONY Affiliations: Dr.