Abstract
Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare and known as “icteric type hepatoma”. Here, we report a case of recurrent HCC with BDTT which was controlled by anatomical resection and hepatic arterial infusion. A 71-year-old woman was admitted for epigastralgy. She was given a diagnosis of HCC, 15 cm in diameter, at the lateral segment. Lateral segmentectomy combined with resection of the diaphragm was performed. The postoperative course was uneventful. Six months later, she was referred to our hospital due to jaundice and recurrence of HCC with BDTT was diagnosed. After biliary decompression and drainage by endoscopic nasobiliary drainage, median segmentectomy, choledochotomy, thrombectomy were performed. As adjuvant chemotherapy, hepatic arterial infusion of Cisplatin was administered for 6 months. She is well without any evidence of recurrence for 32 months since the second surgery. “Icteric type hepatoma” has been reported in only 1.2–9% of HCC cases. The general treatment strategy is anatomical resection in addition to removal of BDTT, however it has been controversial whether the bile duct should be preserved or resected. Considering the high recurrence rate of “icteric type of hepatoma,” we selected hepatic arterial infusion of Cisplatin as adjuvant chemotherapy. The reason for preservation of the extrahepatic duct was to prevent complications of hepatic arterial infusion and to perform additional radiofrequency ablation therapy in case of recurrence in the future.
