Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus

Introduction: This meta-analysis aimed to compare perioperative and survival outcomes in patients who underwent hepatectomy with and without Bile Duct Tumour Thrombus (BDTT). Methods: A comprehensive search of Cochrane Library, PubMed, MEDLINE and EMBASE was performed to identify relevant articles. The perioperative, postoperative and long term outcomes were compared. Results: Eleven studies including 6051 patients met the inclusion criteria. The perioperative outcomes were comparable between the 2 groups. The BDTT group had higher proportion poorly differentiated tumours (OR = 1.87, X-2 = 10.00, df = 6, p = 0.002, I-2 = 40%), Lymphovascular invasion (LVI) (OR = 4.85, X-2 = 28.21, df = 9, p = <0.001, I-2 = 68%) and Macrovascular invasion (MVI) (OR = 5.41, X-2 = 8.73, df = 9, p = <0.001, I-2 = 0%). There was no difference in 1 and 3 year survival, however 5-yr survival was poorer in the BDTT group (OR = 0.37, X-2 = 37.04, df = 7, p = <0.001, I-2 = 81%). The mean difference (MD) in overall survival in the BDTT group was -20 months [-32.31, -7.06], p = 0.002, I-2 = 95%. Conclusion: Patients with HCC with BDTT had more advanced stage HCC with adverse histological features including higher rates of MVI, LVI and poor differentiation. Hepatectomy in this group of patients offers similar survival at 3 years but inferior long-term survival and should be considered when feasible.