Surgical Outcomes of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Korean Multicenter Study Deok-Bog Moon • Shin Hwang • Hee-Jung Wang • Sung-Su Yun • Kyung Sik Kim • Young-Joo Lee • Ki-Hun Kim • Yong-Keun Park • Weiguang Xu • Bong-Wan Kim • Dong Shik Lee • Dong-Hyun Lee • Hong-Jin Kim • Jin Hong Lim • Jin Sub Choi • Yo-Han Park • Sung-Gyu Lee Published online: 28 November 2012 Ó Socie ´te ´ Internationale de Chirurgie 2012 Abstract Background The long-term outcomes after resection for hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT) are unclear. This multicenter study was conducted to determine the prognosis of HCC patients with macroscopic BDTT who underwent resection with curative intent. Methods Of 4,308 patients with HCC from four Korean institutions, this single-arm retrospective study included 73 patients (1.7 %) who underwent resection for HCC with BDTT. Results Jaundice was also present in 34 patients (46.6 %). According to Ueda classification, BDTT was type 2 in 34 cases (46.6 %) and type 3 in 39 cases (53.4 %). Biliary decompression was performed in 33 patients (45.2 %), decreasing the median lowest bilirubin level to 1.4 mg/dL before surgery. Systematic hepatectomy was performed in 69 patients (94.5 %), and concurrent bile duct resection was performed in 31 patients (42.5 %). Surgical curability types were R0 (n = 57; 78.1 %), R1 (n = 11; 15.1 %), and R2 (n = 5; 6.8 %). Patient survival rates were 76.5 % at 1 year, 41.4 % at 3 years, 32.0 % at 5 years, and 17.0 % at 10 years. Recurrence rates were 42.9 % at 1 year, 70.6 % at 3 years, 77.3 % at 5 years, and 81.1 % at 10 years. Results of univariate survival analysis showed that maxi- mal tumor size, bile duct resection, and surgical curability were significant risk factors for survival, and surgical curability was a significant risk factor for recurrence. Multivariate analysis did not reveal any independent risk factors. Conclusions Hepatocellular carcinoma patients with BDTT achieved relatively favorable long-term results after resection; therefore extensive surgery should be recom- mended when complete resection is anticipated. Introduction Hepatocellular carcinoma (HCC) generally spreads through the liver via the portal vein. As a result, portal vein tumor thrombi are frequently observed in imaging studies and resected liver specimens. Rarely, tumor thrombi are detected within the bile duct, where they can cause obstructive jaundice [1, 2]. Jaundice in patients with HCC is typically associated with advanced liver cirrhosis or extensive tumor infiltration. For these patients, life expec- tancy is short, and aggressive treatment modalities, including surgery, are not recommended. In HCC patients with bile duct tumor thrombus (BDTT), obstructive jaun- dice can occur, as in perihilar cholangiocarcinoma [1–5]. These patients exhibit clinicopathological features that differ from those with parenchymal cholestasis, and many have undergone surgery with curative intent. However, D.-B. Moon Á S. Hwang (&) Á Y.-J. Lee Á K.-H. Kim Á Y.-H. Park Á S.-G. Lee Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Gu, Seoul 138-736, Korea e-mail: shwang@amc.seoul.kr H.-J. Wang (&) Á Y.-K. Park Á W. Xu Á B.-W. Kim Department of Surgery, School of Medicine, Ajou University, San 5, Wonchon-Dong, Youngtong-Gu, Suwon 443-749, Korea e-mail: wanghj@ajou.ac.kr S.-S. Yun Á D. S. Lee Á D.-H. Lee Á H.-J. Kim Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea K. S. Kim Á J. H. Lim Á J. S. Choi Department of Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea 123 World J Surg (2013) 37:443–451 DOI 10.1007/s00268-012-1845-0