Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion

Higuchi, Ryota; Yazawa, Takehisa; Uemura, Shuichiro; Izumo, Wataru; Ota, Terukazu; Kiyohara, Kosuke; Furukawa, Toru; Egawa, Hiroto; Yamamoto, Masakazu

doi:10.1007/s11605-018-3948-x

Cited by 34 publications

(25 citation statements)

References 39 publications

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“…Even though a few studies have reported that perioperative outcomes such as perioperative blood transfusion were poor prognostic factors for long-term survival, 12 most studies have revealed tumor-related factors such as lymph node metastasis, R1 resection, high preoperative carcinoembryonic antigen level, poor differentiation, and vascular invasion as independent risk factors for long-term survival after curative treatment of HCCA. 5,[12][13][14][15][16][17][18][19][20][21] Therefore, improved perioperative outcomes might not necessarily improve the long-term survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of perihilar cholangiocarcinoma based on the learning curve of a single surgeon at a tertiary academic hospital: A retrospective study

Park

Han

Choi

et al. 2021

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Although it is difficult to master the surgical learning curve for treatment of perihilar cholangiocarcinoma (HCCA), there have been no studies on surgical outcomes between a novice and an experienced surgeon. Thus, the current study attempted to evaluate surgical outcomes from a single surgeon based on learning curve for surgical treatment of HCCA. Methods: From January 2008 to December 2016, a single surgeon performed surgical treatment for 108 patients with HCCA at Severance Hospital, Seoul, Korea. Among them, 101 patients with curative surgical resection were included in this study. The learning curve was assessed by a moving average graph and CUSUM method using operation time. Surgical outcomes between the early period group (EPG) and the late period group (LPG) were compared according to learning curve. Results: Operation time (603.17±117.59 and 432.03±91.77 minutes; p＜0.001), amount of bleeding during operation (1127.86±689.54 and 613.05±548.31 ml; p＜0.001), and severe complication rates (47.6% and 27.1%, p=0.034) were significantly smaller in the LPG. There was no significant difference in R0 resection rate (85.7% and 76.3%; p=0.241) as well as long-term survival rate. Conclusions: In this study, operation time, amount of bleeding during operation, length of hospital stay, and severe complication rate were improved after stabilization of the learning curve. However, R0 resection rate and survival outcomes were not significantly influenced by the learning curve for surgical treatment of HCCA.

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Section: Discussionmentioning

confidence: 99%

Surgical outcomes of perihilar cholangiocarcinoma based on the learning curve of a single surgeon at a tertiary academic hospital: A retrospective study

Park

Han

Choi

et al. 2021

Ann Hepatobiliary Pancreat Surg

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“…For such advanced PHC, major hepatectomy combined with arterial and portal resection remains the only possibility for obtaining negative margins, although in some earlier studies, it showed higher mortality rates compared to hepatectomy without vascular resection [3][4]. Currently, experience and advances in complex hepatic and vascular surgical techniques have led to more aggressive approaches with acceptable outcomes [1,3,5]. Nagino et al reported a large series of 50 combined arterial and portal resections with a perioperative mortality of 2%.…”

Section: Discussionmentioning

confidence: 99%

“…Vascular invasion is related to more advanced disease and is known as a poor prognostic factor. However, compared to unresectable tumors or resection with positive margins, combined portal vein and hepatic artery resection offers improved survival when feasible [1,[3][4][5].…”

Section: Discussionmentioning

confidence: 99%

Eight-Year Survival Following Left Hepatic Trisectionectomy With Combined Hepatic Artery And Portal Vein Resection For Advanced Perihilar Cholangiocarcinoma

Triki¹,

Jeddou²,

Tzedakis³

et al. 2021

Preprint

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We report the case of a patient with exceptional survival over 8 years after left trisectionectomy combined with portal vein and hepatic artery resection and reconstruction for advanced perihilar cholangiocarcinoma. Such extended hepatectomy with vascular resection is the only way to obtain free tumor margin. It can be performed with acceptable morbidity and mortality and it is the only hope to prolong survival.

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“…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.…”

Section: Literature Searchmentioning

confidence: 99%

“…Therefore, to achieve R0 resection, vascular resection (VR) can be performed during the operation. It has been reported that the proportion of VR during PHC surgery ranges from 15% to 38% (Higuchi et al, 2019;Mizuno et al, 2020;Schimizzi et al, 2018;She et al, 2020;Yu et al, 2017). VR refers to portal vein resection (PVR), hepatic artery resection (HAR) or both.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

et al. 2021

PeerJ

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Objective To evaluate the effect of vascular resection (VR), including portal vein resection (PVR) and hepatic artery resection (HAR), on short- and long-term outcomes in patients with perihilar cholangiocarcinoma (PHC). Background Resection surgery and transplantation are the main treatment methods for PHC that provide a chance of long-term survival. However, the efficacy and safety of VR, including PVR and HAR, for treating PHC remain controversial. Methods This study was registered at the International Prospective Register of Systematic Reviews (CRD42020223330). The EMBASE, PubMed, and Cochrane Library databases were used to search for eligible studies published through November 28, 2020. Studies comparing short- and long-term outcomes between patients who underwent hepatectomy with or without PVR and/or HAR were included. Random- and fixed-effects models were applied to assess the outcomes, including morbidity, mortality, and R0 resection rate, as well as the impact of PVR and HAR on long-term survival. Results Twenty-two studies including 4,091 patients were deemed eligible and included in this study. The meta-analysis showed that PVR did not increase the postoperative morbidity rate (odds ratio (OR): 1.03, 95% confidenceinterval (CI): [0.74–1.42], P = 0.88) and slightly increased the postoperative mortality rate (OR: 1.61, 95% CI [1.02–2.54], P = 0.04). HAR did not increase the postoperative morbidity rate (OR: 1.32, 95% CI [0.83–2.11], P = 0.24) and significantly increased the postoperative mortality rate (OR: 4.20, 95% CI [1.88–9.39], P = 0.0005). Neither PVR nor HAR improved the R0 resection rate (OR: 0.70, 95% CI [0.47–1.03], P = 0.07; OR: 0.77, 95% CI [0.37–1.61], P = 0.49, respectively) or long-term survival (OR: 0.52, 95% CI [0.35–0.76], P = 0.0008; OR: 0.43, 95% CI [0.32–0.57], P < 0.00001, respectively). Conclusions PVR is relatively safe and might benefit certain patients with advanced PHC in terms of long-term survival, but it is not routinely recommended. HAR results in a higher mortality rate and lower overall survival rate, with no proven benefit.

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Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion

Abstract: Short-term outcomes for patients with perihilar cholangiocarcinoma and undergoing vascular resection were poor compared to those without vascular resection. Long-term survival in R0M0 disease was more favorable; aggressive surgery is recommended.

Cited by 34 publications

References 39 publications

Surgical outcomes of perihilar cholangiocarcinoma based on the learning curve of a single surgeon at a tertiary academic hospital: A retrospective study

Surgical outcomes of perihilar cholangiocarcinoma based on the learning curve of a single surgeon at a tertiary academic hospital: A retrospective study

Eight-Year Survival Following Left Hepatic Trisectionectomy With Combined Hepatic Artery And Portal Vein Resection For Advanced Perihilar Cholangiocarcinoma

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

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