Major hepatectomy for perihilar cholangiocarcinoma

Abstract

Background/purpose Hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma involving the hepatic hilus are defined as ''perihilar cholangiocarcinoma''. The principle of surgical treatment is hemi-hepatectomy or trisectionectomy of the liver, caudate lobectomy, and resection of the extrahepatic bile duct for complete resection of the tumor. The aim of this study was to review the outcomes of major hepatectomy for perihilar cholangiocarcinoma. Methods Using the Kaplan-Meier method and the Cox proportional hazards model, we analyzed the results in 125 patients with perihilar cholangiocarcinoma who had undergone major hepatectomy. Results Right hepatectomy, right trisectionectomy, left hepatectomy, and left trisectionectomy were performed in 66, 8, 49, and 2 patients, respectively. Curative resection was achieved in 79 patients (63.2%). Mortality and morbidity rates were 8.0 and 48.7%, respectively. The overall 1-, 3-, and 5-year survival rates of all patients were 73.2, 36.7, and 34.7%, respectively. The median survival was 26.8 months. Multivariate analysis showed that the independent prognostic factors for overall survival were gender, histopathological grading, curative resection, and American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) pT. Conclusions Major hepatectomy for perihilar cholangiocarcinoma was acceptable and showed satisfactory outcomes. For long-term survival in these patients, the surgeon should aim for complete resection of the tumor with negative margins.

Survival Rate of Extrahepatic Cholangiocarcinoma Patients after Surgical Treatment in Thailand

“…Our finding is in line with that of Kosuge et al (1999), who found that patients with a positive resection margin (R1) had a 2.88 times higher mortality risk. The finding was also similar to those reported in other studies (Jarnagin et al, 2005;Witzigmann et al, 2006;Yubin et al, 2008;Unno et al, 2010;Murakami et al, 2011).…”

“…Studies about survival rates or factors affecting the survival of CCA patients after resection, especially those with extrahepatic CCA, are rare, and the results vary from one country to another (Bhudhisawasdi, 1997;Khuntikeo, 2008;American Cancer Society, 2009;Unno et al, 2010). The aim of this study was therefore to evaluate the survival rates and factors affecting survival in extrahepatic CCA patients following surgical treatment at Srinagarind Hospital, Khon Kaen University, Thailand.…”

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…In fact, combined caudate lobe resection is considered as a standard surgical procedure for these diseases in Japan. Japanese high volume centers in which combined caudate lobe resection is routinely performed report relatively high curative resection rate (59-87%) and 5 year survival rate (33-44%) [74,87,124,127,[142][143][144][145][146][147][148]. Several reports from other countries also showed the benefits of this procedure for hilar/upper bile duct carcinoma [149][150][151][152][153][154].…”

Surgical strategy for bile duct cancer: Advances and current limitations

“…Reports from high-volume centers during the last decade are summarized in Table 2 [26, 45,71,73,128,135,142,[146][147][148][149][150][151][152][153][154][155][156][157][158][159][160] . The overall 3-and 5-year survival rates after radical surgery ranged from 37% to 60% and 20% to 42%, respectively.…”