Left hepatectomy combined with hepatic artery resection for hilar cholangiocarcinoma: A retrospective cohort study

Abstract

Left hepatectomy combined with hepatic artery resection and no reconstruction for hilar cholangiocarcinoma is recommended when the following conditions are satisfied: 1) Bismuth-Corlette I, II, or IIIb hilar cholangiocarcinoma; 2) the tumor has infiltrated the hepatic artery with disappearance or markedly reduced arterial flow as detected by intraoperative ultrasound; 3) the color of the liver by visual observation does not change when the hepatic artery has been blocked for 5 min; and 4) removal of the tumor-infiltrated hepatic artery increases the probability of R0 resection for hilar cholangiocarcinoma. For obstructive jaundice from hilar cholangiocarcinoma, we recommend bile duct drainage before resection in patients with elevated preoperative serum TB.

The prognostic value of portal vein and hepatic artery involvement in patients with perihilar cholangiocarcinoma

“…HA reconstruction results in poor short-and longterm outcomes [24][25][26] and should be reserved for highly selected patients. 27 A Japanese study including 224 patients undergoing resection for PHC showed that HA reconstruction was the strongest independent poor prognostic factor with no 3-year survivors. 28 A subgroup analysis to determine the effects of concomitant PV and HA involvement showed that patients with only PV involvement had a median OS of 14.2 months whereas patients with only HA involvement had an inferior OS of 10.6 months.…”

Effect of vascular resection for perihilar cholangiocarcinoma: a systematic review and meta-analysis

“…The total number of patients enrolled was 4,091, and the sample capacities of these studies ranged from 28 to 787 patients. In this meta-analysis, the Full-size  DOI: 10.7717/peerj.12184/fig- 1 rates of PVR during curative surgery for PHC varied from 11% to 73%, with an average rate of 27% (Higuchi et al, 2019;Mizuno et al, 2020;Schimizzi et al, 2018;She et al, 2020;Yu et al, 2017;Peng et al, 2016;Miyazaki et al, 2007;Nagino et al, 2010;De Jong et al, 2012;Dumitraşcu et al, 2017;Igami et al, 2010;Klempnauer et al, 1997;Kondo et al, 2004;Lee et al, 2010;Matsuyama et al, 2016;Muñoz et al, 2002;Song et al, 2009;Tamoto et al, 2014;Wang et al, 2015).…”

“…Eleven studies containing 2,189 patients provided data on overall morbidity (Mizuno et al, 2020;Schimizzi et al, 2018;She et al, 2020;Yu et al, 2017;Peng et al, 2016;Miyazaki et al, 2007;Matsuyama et al, 2016;Song et al, 2009;Tamoto et al, 2014;Wang et al, 2015). The meta-analysis indicated no difference in morbidity between the patients with and without VR (OR: 1.04, 95% CI [0.86-1.26], P = 0.68) (Fig.…”

“…Among them, 88 records were further excluded for the following reasons: not in English (n = 7); abstract form only (n = 38); contained other malignancies or benign tumors (n = 2); reconstruction or no reconstruction as comparison item (n = 2); inadequate data (n = 7); and case reports (n = 32). Finally, 22 studies (Higuchi et al, 2019;Mizuno et al, 2020;Schimizzi et al, 2018;She et al, 2020;Yu et al, 2017;Peng et al, 2016;Miyazaki et al, 2007;Nagino et al, 2010;De Jong et al, 2012;Dumitraşcu et al, 2017;Igami et al, 2010;Klempnauer et al, 1997;Kondo et al, 2004;Lee et al, 2010;Matsuyama et al, 2016;Muñoz et al, 2002;Song et al, 2009;Tamoto et al, 2014;Wang et al, 2015) including 4091 PHC patients were eligible for this systematic review and meta-analysis.…”

“…However, found that PVR greatly increased the perioperative morbidity rate and had no benefit for PHC in terms of the oncologic outcomes. In addition, surgical resection with simultaneous HAR for PHC is a demanding procedure (Miyazaki et al, 2007;Peng et al, 2016;Shimada et al, 2003;Yamanaka et al, 2001). Similar to PVR, attitudes toward HAR remain inconsistent.…”