Outcomes of liver resection for hepatocellular carcinoma with obstructive jaundice

Abstract

INTRODUCTION: Obstructive jaundice (OJ) is an uncommon presentation in hepatocellular carcinoma (HCC). It is controversial whether OJ implies a poorer prognosis and few reports on long-term survival were published. METHOD: This was a retrospective study conducted in a university centre in Hong Kong. Surgical outcomes and survival of 38 HCC patients presented with OJ and underwent liver resection were analyzed and compared to 228 matched non-OJ HCC patients. RESULTS: Baseline demographics were similar in terms of age, sex, hepatitis B status and presence of co-morbid diseases. Patients in OJ group had a significantly higher preoperative bilirubin (18 vs. 11 mg/dl, p < 0.001), lower albumin (37.5 vs. 40 g/l, p = 0.001) and more patients were of Child’s B (42.1 vs. 3.1%, p < 0.001). Other parameters including INR (1.1 vs. 1, p = 0.186), indocyanine green retention at 15 minutes (13 vs. 11.3, p = 0.267) and alpha fetoprotein (63 vs. 175 ng/ml, p = 0.75) were the same. Majority of patients (34/38, 89.5%) with OJ required preoperative intervention to alleviate jaundice. Thirty-three patients (86.8%) and 167 (73.2%) in OJ and control group underwent major hepatectomy (p = 0.07) respectively. More patients in OJ group required hepaticojejunostomy (12/38 vs. 4/228, p < 0.001) and portal vein resection (4/38 vs. 3/228, p = 0.007). Operative time was longer in OJ group (488.5 vs. 400 minutes, p = 0.002), more blood loss (1.33 vs. 0.9 l, p = 0.019) and had more complications (50 vs. 31.1%, p = 0.023) but hospital mortality was the same (2.6 vs. 3.9%, p = 0.844). The 5-year overall and disease free survival were similar; 37.4% vs. 33.7% and 20.5% vs. 20.8% in OJ and control group respectively. Prognosis was poorer in those with larger tumor, presence of microvascular permeation, higher prothrombin time and more blood loss while OJ itself would not confer an inferior survival. CONCLUSIONS: Liver resection should be offered whenever possible and survival after liver resection is not jeopardized in OJ patients.