Results of surgical treatments and prognostic factors for hepatic hilar bile duct cancer

Abstract

Results of surgical treatments for 57 patients who underwent resection for hepatic hilar bile duct cancer between 1984 and 1997 were studied. Bile duct resection was performed in eight patients, and combined resection of bile duct and liver was performed in 49 patients, of whom vascular reconstruction was added in 15 patients and pancreatoduodenectomy (PD) in six patients. All the operations of bile duct resection that were not combined with hepatectomy were non-curative. In the patients who underwent combined resection of the bile duct with liver, outcomes of the patients with well-differentiated adenocarcinoma were better than those with other lower-grade tumors. The factors related to the degree of tumor extension, such as serosal invasion, lymph node metastasis, lymphatic vessel invasion, perineural invasion, venous vessel invasion, and vascular involvement, were other factors which significantly influenced the survival. Curative resection yielded significantly better results than non-curative resection. Of all these variables, good tumor differentiation and vascular involvement were recognized as important prognostic factors by multivariate analysis. Most of the postoperative deaths were encountered in patients who underwent additional operations to hepatectomy, such as vascular reconstruction or PD. Improvement of surgical techniques and perioperative care has yielded better outcomes of vascular reconstruction. However, the application of hepatopancreatoduodenectomy should be limited due to poor outcomes of widespread bile duct cancer of which the histological grade is usually low. Whereas prognosis of bile duct cancer involving the hepatic hilus is mainly determined by the biologic characteristics of the tumor, surgeons should consider the fact that most patients die of local recurrence regardless of the biologic character of the tumor when curative resection is not performed.

Immunohistochemically Demonstrated Lymph Node Micrometastasis and Prognosis in Patients With Otherwise Node-Negative Hilar Cholangiocarcinoma

“…Recent evidence suggests that extended lymphadenectomy may prolong survival in selected patients with gallbladder cancer 36,37 or hilar cholangiocarcinoma. [5][6][7][8]14 Boniest et al 38 reported that regional lymphadenectomy in the hepatoduodenal ligament was effective for improving outcome in gallbladder cancer patients without overt nodal metastasis. In the present study, nodal micrometastasis occurred in about one fourth of patients with histologically node-negative hilar cholangiocarcinoma, while most micrometastases were found in N2 rather than N1 regional lymph node groups.…”

Complications of Hepatectomy for Hilar Cholangiocarcinoma

“…With the recent advances in the anatomic knowledge of the liver and hepatic hilus, improved diagnostic and surgical techniques, and refinements in pre-and postoperative management, aggressive liver and bile duct resection has frequently been performed for hilar cholangiocarcinoma with varying degrees of success [1][2][3][4][5][6][7][8][9][10]. Several surgeons have reported that hepatectomy with en bloc resection of the caudate lobe and the extrahepatic bile duct offers a better chance of long-term survival by producing tumorfree margins in the intrahepatic bile ducts [1,3,4,7,9,10]. Postoperative morbidity and mortality rates after hepatectomy, however, remain high [1][2][3][4][5][6][7][8][9][10].…”

Papillary adenocarcinoma of the subvesical duct

“…Bile duct cancers are generally associated with an unfavorable prognosis,7,8 and several prognostic factors have been reported. Papillary lesions, which are uncommon, have a better prognosis than other types of carcinomas.…”

“…1,5 Inadvertent division of the subvesical duct during cholecystectomy may cause postoperative leakage of bile. 6 Bile duct cancers are generally associated with an unfavorable prognosis, 7,8 and several prognostic factors have been reported. Papillary lesions, which are uncommon, have a better prognosis than other types of carcinomas.…”