The occurrence rate of
BDT was 1.84% (223/12,114) in our study. The radical resection rate in types I, II, III, and IV was 70% (7/10), 38.46% (10/26), 20.4% (29/142), 33.3% (2/6), respectively. The mean survival time in patients who underwent radical hepatic resection and
BDT removal (group A), palliative
hepatectomy and
BDT removal (group B), palliative
hepatectomy and
BDT removal plus unilateral liver artery
ligation or postoperative transcatheter arterial chemoembolization (TACE; group C), TACE (group D), drainage to relieve the
jaundice by ERCP or PTCD (group E), and
conservative treatment (group F) was 37, 6, 16, 11, 3.0, 3.0 months, respectively. The survival rate of patients in group A was significantly greater than in other group (P < 0.0001); the rate in groups C and D was significantly higher than that in groups B, E, and F (P < 0.001). In group A, 1-year recurrence rate was 20.8% (10/48). One patient with severe
jaundice suffered
chronic liver failure after right lobe resection and died 2 months after operation. In groups B, C, D, E, and F, in ten cases,
cholangitis occurred, in eight cases,
hemobilia occurred, and 72 of 136 patients suffered
liver failure and died within 6 months. Five patients underwent orthotopic
liver transplantation; at the time of writing, three patients are still alive, and the longest survivor has now survived for 37 months since undergoing
transplantation.
CONCLUSIONS: Radical hepatic resection and removal of
BDT, combined with TACE, are the best approach for treating HCC patients with
BDT. Biliary drainage to relieve the
jaundice is critical.