Laparoscopic radical resection of hilar cholangiocarcinoma: a report of 32 patients

Abstract

Objective To analyze the clinical outcomes and surgical procedures of 32 patients who underwent laparoscopic radical resection of hilar cholangiocarcinoma. Methods From January 2013 to July 2018, 32 patients who were diagnosed to have hilar cholangiocarcinoma underwent total laparoscopic treatment in Second Hospital of Hebei Medical University. The clinical data of these patients were recorded, including the general data, Bismuth types, AJCC types, postoperative complications, pathological findings, and follow-up results. Results This study included 20 males and 12 females with a mean age of 60.9±8.8 years and a body mass index of 22.6±3.2 kg/m2. According to the preoperative imaging studies, the Bismuth types Ⅰ, Ⅱ, Ⅲa, Ⅲb, and Ⅳ were found in 12, 2, 3, 4 and 11 patients, respectively. Laparoscopic radical resection of hilar cholangiocarcinoma and bilioenteric anastomosis was performed in 12 patients, with radical resection and external bile drainage in 6 patients, extended hemihepatectomy with caudate lobectomy in 6 patients and concomitant portal vein resection in 2 patients. The mean operative time was 365.6±121.9 min and the median intraoperative blood loss was 300 (75, 400) ml. Intraoperative red cell and plasma transfusion were 0-15 U and 400(0, 625)ml, respectively. According to the Clavien-Dindo complication classification system, 5 of 32 (15.6%) patients developed type Ⅱ morbidity. The postoperative pathological findings revealed bile duct adenocarcinoma in 30 patients and mucinous adenocarcinoma in 2 patients. The median size of cancer was 3.0 (1.0, 3.5) cm. According to the 8th AJCC staging system, stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ were found in 6, 13, 11, and 2 patients, respectively. A negative resection margin was achieved in 24 of 32 patients (75%). Up to August 6, 30 of 32 patients (93.8%) were followed up and the overall 1-, 2-, and 3-year survival rates for the patients who underwent laparoscopic radical resection for hilar cholangiocarcinoma were 80.0%, 53.0%, and 53.3%. The median survival time was 21.8 months. Conclusion Total laparoscopic surgery for hilar cholangiocarcinoma was safe and feasible if performed by an experienced surgeon after accurate preoperative evaluation. Key words: Bile duct neoplasms; Surgical procedures, minimally invasive; Laparoscopy; Drainage; Hilar cholangiocarcinoma