Xiao P, Chen KX, Jiang LL, Zhang L. Hepatocellular carcinoma with obstructive jaundice: Biliary drainage and multimodal therapy. World J Hepatol 2026; 18(9): 124789 [DOI: 10.4254/wjh.124789]
Corresponding Author of This Article
Lian-Lu Jiang, Chief Physician, Researcher, Department of Hepatobiliary, Pancreatic and Splenic Surgery, First Affiliated Hospital of Hunan College of TCM (Hunan Province Directly Affiliated TCM Hospital), No. 50 Renmin Middle Road, Lusong District, Zhuzhou 412000, Hunan Province, China. jiexiu666@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Sep 27, 2026; 18(9): 124789 Published online Sep 27, 2026. doi: 10.4254/wjh.124789
Hepatocellular carcinoma with obstructive jaundice: Biliary drainage and multimodal therapy
Pan Xiao, Ke-Xin Chen, Lian-Lu Jiang, Li Zhang
Pan Xiao, Ke-Xin Chen, Li Zhang, Department of Interventional Medicine, Guilin People’s Hospital, Guilin 541000, Guangxi Zhuang Autonomous Region, China
Lian-Lu Jiang, Department of Hepatobiliary, Pancreatic and Splenic Surgery, First Affiliated Hospital of Hunan College of TCM (Hunan Province Directly Affiliated TCM Hospital), Zhuzhou 412000, Hunan Province, China
Co-first authors: Pan Xiao and Ke-Xin Chen.
Co-corresponding authors: Lian-Lu Jiang and Li Zhang.
Author contributions: Xiao P contributed to conceptualization, literature investigation, and writing - original draft; Chen KX contributed to literature search, evidence verification, and writing - review and editing; Xiao P and Chen KX contributed equally to this manuscript as co-first authors; Zhang L and Jiang LL contributed to conceptualization, supervision, project administration, and critical revision, and they contributed equally to this manuscript as co-corresponding authors. All authors read and approved the final manuscript.
AI contribution statement: OpenAI ChatGPT was used solely for English language editing and proofreading to improve grammar, clarity, and readability. The authors critically reviewed and approved all revisions. The AI tool was not used to generate scientific content, data, references, figures, tables, analyses, or conclusions. The authors take full responsibility for the accuracy, integrity, and originality of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Lian-Lu Jiang, Chief Physician, Researcher, Department of Hepatobiliary, Pancreatic and Splenic Surgery, First Affiliated Hospital of Hunan College of TCM (Hunan Province Directly Affiliated TCM Hospital), No. 50 Renmin Middle Road, Lusong District, Zhuzhou 412000, Hunan Province, China. jiexiu666@gmail.com
Received: June 24, 2026 Revised: July 23, 2026 Accepted: August 14, 2026 Published online: September 27, 2026 Processing time: 85 Days and 12.8 Hours
Abstract
Obstructive jaundice is an uncommon manifestation of hepatocellular carcinoma (HCC), reported in 1%-12% of patients, and must be distinguished from jaundice caused by diffuse hepatic failure. This narrative review evaluates HCC with an imaging-supported mechanical obstructive component caused by bile duct tumor thrombus, extrinsic compression, intraductal growth, or hemobilia. HCC-specific studies use heterogeneous definitions of successful drainage, including bilirubin reductions of > 30% or ≥ 50% and absolute thresholds below 2-3 mg/dL. Retrospective series suggest that endoscopic or percutaneous drainage can relieve cholestasis and permit reassessment for surgery, transarterial chemoembolization, radiotherapy, or systemic treatment in selected patients. However, comparisons between patients who did and did not receive subsequent therapy are strongly confounded by liver function, performance status, tumor burden, and drainage response. Direct evidence is greatest for drainage followed by transarterial chemoembolization; evidence for hepatic arterial infusion chemotherapy, radiotherapy, immune checkpoint inhibitor regimens, and liver transplantation remains limited to small retrospective series, case reports, or extrapolation from broader HCC populations. We propose an evidence-calibrated multidisciplinary framework that prioritizes confirmation of mechanical obstruction, individualized drainage, clinical reassessment, and explicit recognition of evidentiary uncertainty.
Core Tip: Patients with hepatocellular carcinoma-related jaundice should first be evaluated for a mechanical obstructive component rather than assumed to have irreversible liver failure. Endoscopic or percutaneous drainage may relieve cholestasis and allow treatment reassessment, but response definitions vary and apparent survival advantages are vulnerable to selection bias. Transarterial chemoembolization has the largest direct post-drainage evidence base; hepatic arterial infusion chemotherapy, radiotherapy, systemic therapy, and transplantation are supported mainly by small retrospective studies, case reports, or extrapolation. Drainage modality and subsequent treatment should be individualized by a multidisciplinary team, with clinical trials preferred whenever feasible.
