Recently, five patients with HCC(hepatocellular carcinoma) obstruction biliary duct by the .4 tumor fragments were treated. The diagnosis was totally unsuspected in first two cases, patient one and two(pt # 1, pt #2). Space occupying lesions seen on imaging studies, elevated aFP, positive HBsAg, and previous history of chronic liver disease helped in making a diagnosis of this unusual presentation of HCC. In the first 2 cases, liver parenchymal lesions were never observed on perioperative studies and postoperative serial check ups as well until patient´s
deaths, on postoperative day 229 and 215 respectively. In 3 patients (pt #2, pt #3, pt #4), ´ evacuation of obstructing materials and T-tube decompression was done. In one patient (pt #5), right hepatic lobectomy was carried out after initial tube decompression of the biliary system. The other patient (pt #1) underwent cholecystectomy, enbloc resection of bile duct including obstruction mass, and Roux-en-Y cholangio-jejunostomy. In 4 out of 5 cases, obstructing tumor thrombi reccurred postoperatively. Repeated choledochoscopy was necessary to keep the bile duct free of tumor thrombi. In conclusion, not all the patients who present with obstructive jaundice may be terminally ill when they treated properly. The biliary drain by the mean of T-tube decompression can be a palliative procedure of choice in these patients. The ideal treatment is complete removal of the tumor by major hepatic resection, which may not be feasible in most patients. However, even when patient present with resectable lesion, those who have en-tire biliary systems including small and medium sized duct packed with tumor thrombi would not have long survival intervals with hepatic resection
|