In hepatocellular carcinoma the obstructive jaundice due to tumor infiltration, hemobilia, or tumor compression is uncommon clinial feature. Only a few cases have been reported, since Mallory reported the first case in 1947.
The prognosis of hepatocellular carcinoma with bile duct tumor thrombosis has been reported to be very poor. And most of the treatment used to be palliative procedures. Such as T-tube decompression, ligation of hepatic artery, or transarterial
embolization.
Recently, the refinement of surgical technique and perioperative metabolic management caused massive hapatic resection to be performed safely.
From June 1984 to March 1995, 88 patients with hepatocellular carcinoma underwent operation at the Youngnam University Medical Center. Of them, 6 patients manifested with jaundice due to bile duct tumor thrombosis. We performed hepatectomy for 4
patients, and tumor embolectomy with T-tube decompression for 2 patients. Among them. 2 patients who had received hepatectomy survived more than 2 years.
In conclusion the aggressive surgical approach for the hepatocellular carcinoma presenting as an obstructive jaunding secondary to tumor thrombosis in the bile duct should be considered for long term survival.
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