Leakage and Stenosis of the Hepaticojejunostomy Following Surgery for Perihilar Cholangiocarcinoma.

Jan Bednarsch,Daniel Heise,Philipp Bruners,Tom Luedde,Tom Florian Ulmer,Sven Arke Lang,Zoltan Czigany,Steven W M Olde Damink,Ulf Peter Neumann

doi:10.3390/jcm9051392

Jan Bednarsch, Daniel Heise + Show 7 more

Open Access

https://doi.org/10.3390/jcm9051392

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Abstract

This study aims to provide a deep insight into the incidence and clinical significance of postoperative anastomotic leakage (AL) and anastomotic stenosis (AS) of the hepaticojejunostomy (HJ) after curative-intent liver resection for perihilar cholangiocarcinoma (pCCA). Between 2011 and mid-2019, 114 patients with pCCA underwent surgery in curative intent at our institution and were analyzed regarding the postoperative incidence of AL and AS. Further, associations between AL and AS and clinical characteristics were assessed using multiple univariate logistic regression analyses. AL was diagnosed in 11.4% (13/114) of the patients resulting in postoperative mortality in the minority of patients (23.0%, 3/13). AS occurred in 11.0% (11/100) of the individuals eligible for follow-up with local tumor recurrence being the underlying pathology in 72.7% (8/11) of the cases. None of the investigated clinical factors including surgical difficulty of the HJ showed a meaningful association with AL or AS. AL and AS are frequent complications and can be treated by conservative, interventional or surgical therapy with a high success rate. Also, technical difficulty of the HJ appears not to be not associated with the occurrence of AL or AS. Moreover, AS is associated with tumor recurrence in the majority of cases.

Highlights

Cholangiocellular carcinoma (CCA) is the second most common malignancy of the liver harboring a dismal oncologic prognosis as CCAs are generically diagnosed at advanced disease stages [1,2,3]
Major liver resections with the concomitant resection of the extrahepatic bile duct and en-bloc lymphadenectomy have evolved as the gold standard of treatment for patients with perihilar CCA (pCCA) [10,18]
HJ is a major step of the complex surgical procedure, short- and long-term complications such as leakage and stenosis and their impact on clinical outcomes are yet to be reported

Summary

Introduction

Cholangiocellular carcinoma (CCA) is the second most common malignancy of the liver harboring a dismal oncologic prognosis as CCAs are generically diagnosed at advanced disease stages [1,2,3]. Surgical resection for CCA is usually associated with a significant perioperative mortality up to 12% in contrast to partial hepatectomies for other malignancies which are generally considered safe in experienced high-volume centers [6,7,8]. The resection of the extrahepatic and intrahepatic biliary tree leaves us with multiple, often small segmental bile ducts at the resection plane of the remnant liver which have to be reconstructed. These complex hepticojejunostomies (HJs) are burdened with technical challenges and possible pitfalls for the perioperative outcome in these patients

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