1. HCC with bile duct tumor thrombi (HCC c BDTT) disease review 1

2. Introduction Mallory et al. reported the first such case in 1947 Lin et al. classified as ‘‘icteric type hepatoma’’ in 1975 1-12% as initial complaint for HCC feature high level of serum AFP history of cholangitis with dilation of intrahepatic bile duct aggravating jaundice and rapidly developing into liver dysfunction

3. Mechanism a fragment of necrotic tumor may separate from the proximal intra-ductal growth, migrate to the distal CBD, and cause an obstruction hemorrhage from the tumor may partially or completely fill the biliary tract with tumor-containing blood clots

4. Department of General Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat- Sen University From December 2002 to December 2008 676 HCC patients underwent surgical treatment

5. Clinicopathological features TACE could increase the possibility of CBD obstruction of tumor thrombi Spahr L, Frossard JL, Felley C, Brundler MA, Majno PE, Hadengue A. Biliary migration of hepatocellular carcinoma fragment after transcatheter arterial chemoembolization therapy. Eur J Gastroenterol Hepatol 2000; 12: 243-244

6. Immunohistochemical features

7. Treatment treatment modality choledochotomy with T-tube drainage alone internal biliary stenting or biliary diversion lobectomy hepatectomy plus thrombectomy choledochotomy → cause tumor seeding prognosis: poor in those patients having palliative tube drainage aggressive HR with removal of the extrahepatic bile duct → prolongation of survival

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9. 9 HCC c BDTT 1, 3, 5-year survival rates: 70.3%, 25.9%, 7.4% HCC s BDTT 1, 3, 5-year survival rates: 90.6%, 54.0%, 37.7% En bloc resection: 3/27 명

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11. 11 favorable prognosis: macroscopic bile duct invassion no intrahepatic metastases curative surgical resection

13. Selection criteria of LT for HCC

14. Technical knacks to facilitate curative resection

15. Suggestions for advanced HCC curative resection showed a favorable outcome: 70.6% of overall 5-YSR today no consensus about the transplantability of HCC c BDTT tumors permitting en bloc resection of the extrahepatic bile duct may present an indication for LT as a survival gain may be expected