To investigate the clinicopathological characteristics and surgical outcome of hepatocellular carcinoma (HCC) with bile duct invasion (BDI).

Clinical data of 446 patients with HCC undergoing curative hepatectomy from January 2001 to January 2010 was studied retrospectively. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. The patients were divided into bile duct invasion group(BDI group) and non-BDI group. There were 24 males and 11 females in BDI group with the madian age of (51.3±2.0) years. Patients in this group underwent curative hepatectomy or curative hepatectomy plus choledochojejunostomy or tumor thrombectomy plus T tube drainage. There were 329 males and 82 females in non-BDI group with the median age of (50.5±0.5) years. Patients in this group underwent curative hepatectomy. Clinicopathological parameters were collected and the operation data were compared. All the patients were followed up after the operation. The survival rate were recorded and analyzed. The age, preoperative examinations, operation time, intraoperative blood transfusion and hospital stay of all patients in two groups were compared by Mann-Whitney U test or t test. The gender ratio, cases with combined hepatitis and cirrhosis, evaluation of liver function according to Child-Pugh grading, pathological parameters of tumors, the incidence of postoperative complications in the two groups were compared by χ² or Fisher’s exact test; The survival curves were plotted using Kaplan-Meier methods and compared by Log-rank test.

The average preoperative total bilirubin level was (54±19) μmol/L and (22±2) μmol/L in BDI group and non-BDI group. There were significant differences in tumor size, tumor numbers, portal vein and microvascular invasion between the two groups were significant (χ²=9.715, 10.232, 12.543, 20.423; all in P<0.05) , but no significant differences in the tumor capsule, satellite nodules or tumor differentiation (all in P>0.05) ; There were 23 cases with surgical margin less than 1 cm in BDI group and 12 cases lager or equal to 1 cm. There were 180 cases with surgical margin smaller than 1 cm in non-BDI group and 231 cases lager or equal to 1 cm. There were significant differences between two groups (χ²=6.248, P=0.012) . The operation time, intraoperative blood transfusion and hospital stay time for BDI and non-BDI group were (5.6±1.2) h, (603±87) ml, (24.6±1.6) d and (4.2±0.5) h, (666±25) ml, (23.6±0.8) d respectively, in which there were no significant differences (t=0.275, 0.779, 0.688; all in P>0.05). The incidence of postoperative complications were 26% (9/35) in BDI group and 41% (168/411) in non-BDI group, in which there were no significant differences (χ²=1.253, P>0.05) . The 1- and 3-year survival rate were 46%, 25% in BDI group, and 75%, 42% in non-BDI group respectively. The median survival time was 18.5 months in BDI group and 46 months in non-BDI group (χ²=16.594, P<0.001) . For the subclassification of BDI, there was significant difference in the survival rate between B1 and B0, B1 and B3 (χ²=20.962, 12.119; all in P<0.001) , but was not between B3 and B0 (χ²=0.314, P<0.05) .

Preoperative jaundice is a clinical characteristic of HCC with bile duct invasion. BDI should be suspected when HCC patients complained with jaundice. Tumor size larger than 5 cm, multiple tumor numbers, portal vein and microvascular invasion are highly correlated with BDI. HCC with BDI indicates high degree of pathological malignancy and poor outcome. Curative resection remains the optimal therapy for patients with long term survival.