Thrombus-First Surgery for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus

Objective The optimal surgical method of patients with hepatocellular carcinoma (HCC) and bile duct tumor thrombus (BDTT) is still controversial. This study aims to investigate the impact of different surgical methods on BDTT patients. Methods A multicenter retrospective study was carried out on HCC patients with BDTT who underwent surgery. The survival outcomes of different operation methods were studied. Results A total of 120 HCC patients with BDTT from 5 different clinical centers were included. The median disease-free survival (DFS) of the bile duct resection (BDR) group was significantly better than that of the non-BDR group (24.6 months vs. 18.9 months, p = 0.034), but the overall survival (OS) was similar between the two groups (33.6 months vs. 32.3 months, p = 0.193). When we divided the non-BDR group into two groups according to the operation sequence of the hepatic tumor and BDTT, we found that the OS of the thrombus-first group was significantly longer than that of the tumor-first group (42.7 months vs. 23.6 months, p = 0.016). When compared with the BDR group, the thrombus-first group showed similar OS (42.7 months vs. 33.6 months, p = 0.653) and DFS (24.7 months vs. 24.6 months, p = 0.150), which may be the reason the OS rate of the BDR group was similar to that of the non-BDR group. Conclusions A thrombus-first technique could be considered for HCC patients with extrahepatic BDTT, especially for those patients in which the tumor thrombus did not invade the bile duct.