Surgical resection for hepatocellular carcinoma with bile duct tumor thrombus

Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is relatively rare, with an incidence of about 1.2% to 12.9%. 1 Zeng H. Xu L.B. Wen J.M. et al. Hepatocellular carcinoma with bile duct tumor thrombus: a clinicopathological analysis of factors predictive of recurrence and outcome after surgery. Medicine (Baltimore). 2015; 94: e364 Crossref PubMed Scopus (21) Google Scholar Surgical resection is the preferred treatment for HCC with BDTT; however, whether the extrahepatic bile duct should be preserved or resected remains controversial. 2 Shiomi M. Kamiya J. Nagino M. et al. Hepatocellular carcinoma with biliary tumor thrombi: aggressive operative approach after appropriate preoperative management. Surgery. 2001; 129: 692-698 Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar , 3 Kim D.S. Kim B.W. Hatano E. et al. Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korea-Japan multicenter study. Ann Surg. 2020; 271: 913-921 Crossref PubMed Scopus (17) Google Scholar , 4 Yamamoto S. Hasegawa K. Inoue Y. et al. Bile duct preserving surgery for hepatocellular carcinoma with bile duct tumor thrombus. Ann Surg. 2015; 261: e123-e125 Crossref PubMed Scopus (17) Google Scholar BDTT rarely invades the walls of the extrahepatic bile duct due to its expansive growth characteristics. Thus, most BDTT can be treated with tumor thrombectomy, avoiding resection of the extrahepatic bile duct. 4 Yamamoto S. Hasegawa K. Inoue Y. et al. Bile duct preserving surgery for hepatocellular carcinoma with bile duct tumor thrombus. Ann Surg. 2015; 261: e123-e125 Crossref PubMed Scopus (17) Google Scholar The reported techniques include choledochotomic thrombectomy, endoscopic thrombectomy, and peeling-off thrombectomy. 4 Yamamoto S. Hasegawa K. Inoue Y. et al. Bile duct preserving surgery for hepatocellular carcinoma with bile duct tumor thrombus. Ann Surg. 2015; 261: e123-e125 Crossref PubMed Scopus (17) Google Scholar ,5 Inoue T. Ohashi T. Nakade Y. et al. Diagnostic utility of digital cholangioscopy for dislodged bile duct tumor thrombus of hepatocellular carcinoma. Endoscopy. 2017; 49: E33-E34 Crossref PubMed Scopus (1) Google Scholar