Hilar cholangiocarcinoma: Change of the concept for radical resections

Abstract

Background: The long-term outcomes depend heavily on the possibility of performing radical resection. Purpose To evaluate the influence of different criteria on the long-term Results in patients with hilar cholangiocarcinoma after R0, R1 and R1+ resections. Methods: From 2004 to 2017 in A.V. Vishnevsky Centre of Surgery retrospectively analyzed 75 patients who underwent surgical resection. Bismuth-type IV tumor was in 44 (58.7%), IIIa – 10 (13.3%), IIIb – 16 (21,3%), II – 3 (4%), I - 2 (2.7%). 60 (80%) patients underwent hemihepatectomy (14 - extended hemihepatectomy), 5 (6.7%) - only extrahepatic bile duct resection. 10 (13,3%) patients underwent resection S4b,5 with en bloc resection of extrahepatic bile duct. The influence of the wedge R status of the bile duct, nodal status, microvascular invasion, microlymphatic invasion, perineural invasion, microscopic liver invasion, surrounding adipose tissue invasion on survival were tested by the Cox’s models. The survival rates depending on the number of the pathological parameters were compared by the log-rank test. Results: The 1-, 3-, 5-years survival rates were 78%, 31% и 22%, respectively. Wedge resection, nodal status, microvascular invasion, microlymphatic invasion, perineural invasion, microscopic liver invasion, surrounding adipose tissue invasion were used as extended criteria for curability (R+, from 1 to 7 parameters). For status R0 resection are negative 7 parameters. For status R1 resection (R+1, R+2) are negative 5 parameters. For status R1+ resection (R+3, R+4, R+5, R+6, R+7) are positive from 3 to 7 parameters. 5-year survival rate was 100% for R0 and R1 resections and 1- 2- 3-years survival rates were 80%, 56%, 18% for R1+ resections. The new criteria for determination of the level of radical resections correlated with long-term outcomes (Ñ€=0,004). Conclusions: Complex criteria for determination of radical resections are useful for prognosis and aggressive adjuvant therapy in patients with hilar cholangiocarcinoma.Tabled 1Caption 1: Criteria for Radical Resections.