To investigate the pathological characteristics of bile duct tumor thrombi (BDTT) and its influence on the prognosis of patients with hepatocellular carcinoma (HCC) after surgical treatments.

Clinical data of 26 patients with HCC and BDTT (23 males, 3 females, age ranging from 23 to 78 years old and the median age of 52 years old) who underwent hepatectomy in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2007 to June 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The surgical procedures included regular hepatectomy (n=12), irregular hepatectomy (n=14). The treatments for BDTT included bile duct thrombectomy (n=13), extrahepatic bile duct resection (n=8), combined resection of BDTT and tumor (n=5). The pathological characteristics of BDTT were observed and its correlation with tumor recurrence was analyzed. The comparison of rates was conducted by Fisher's exact probability test.

Two cases of pure small microscopic BDTT and 24 cases of big macroscopic BDTT (14 cases were combined with pure small microscopic BDTT) were observed. According to the Satoh's BDTT clinical classification, there were 3 cases of typeⅠ, and 21 cases of type Ⅱ in 24 cases of big macroscopic BDTT. In all 26 cases of BDTT, sub-epithelium spreading along the bile duct wall was observed in 23 cases, most of which were small microscopic BDTT or big macroscopic BDTT. Intraductal spreading was rare and was observed mostly at the end part of big macroscopic BDTT. During the follow-up, intrahepatic tumor recurrence was observed in 10 cases, in which 8 cases were combined with BDTT recurrence. The intrahepatic tumor recurrence rate was 3/9 in patients after regular hepatectomy, and was 58% (7/12) in patients after irregular hepatectomy. In the 13 cases receiving bile duct thrombectomy, 7 cases suffered from BDTT recurrence with the recurrence rate of 54% (7/13). In the 8 cases receiving extrahepatic bile duct resection, 1 case suffered from BDTT recurrence with the recurrence rate of 1/8, where significant difference was observed (P<0.05).

BDTT of HCC includes macroscopic BDTT and microscopic BDTT. BDTT spreads mostly in sub-epithelium along the bile duct wall. Tumor recurrence rate may be reduced and the outcome may be improved by surgical treatments of regular hepatectomy combined with extrahepatic bile duct resection.