New types of operation based on perihilar resection to cure hilar cholangiocarcinoma

Abstract

Objective To explore clinical efficacy of new types of operation based on perihilar resection to cure hilar cholangiocarcinoma. Methods The retrospective descriptive study was conducted. The clinico-pathological data of 4 patients with different Bismuth type of hilar cholangiocarcinoma who were admitted to the Beijing Tsinghua Chunggung Hospital from December 2014 to June 2016 were collected. After preoperative examinations and evaluations, single perihilar resection or combined with central liver segmentectomy were performed. Observation indicators included: (1) intraoperative situations; (2) postoperative pathological examinations; (3) postoperative situations; (4) follow-up. Patients were followed up using outpatient examination up to June 2017. Follow-up included abdominal pain, fever, routine blood test, tumor marker test and imaging examination which detected tumor recurrence and metastasis. Measurement data were represented as average (range). Results (1) Intraoperative situations: 4 patients received successful operations, with an average operation time of 512 minutes (range, 300-620 minutes). Portal vein was blocked continuously, with an average occlusion time of 70 minutes (range, 57-80 minutes), an average volume of intraoperative blood loss was 537 mL (range, 200-1 000 mL). Two patients received transfusion of 2 U plasma, 4 U plasma + 4 U red blood cell (RBC), respectively. (2) Postoperative pathological examinations: results of postoperative pathological examinations in 4 patients showed that tumor size was respectively 1.5 cm×1.2 cm×1.1 cm, 1.3 cm×1.1 cm×1.0 cm, 2.0 cm×1.7 cm×1.5 cm and 2.0 cm×2.0 cm×1.5 cm. Tumor differentiation: 1 and 3 patients were respectively detected in moderate-differentiated cholangiocarcinoma and low-differentiated cholangiocarcinoma. Positive nerve plexus invasion was found in all 4 patients and 3 patients had regional lymph node metastasis. Four patients received R0 resection. TNM staging: T2aN1M0 and T2bN1M0 were found in 1 and 3 patients, respectively. (3) Postoperative situations: of 4 patients, 1 complicated with biliary leakage was cured by conservative treatment and then discharged from hospital at 67 days; 3 had good recovery and then discharged from hospital at day 21, 14 and 14, respectively. Patients didn′t receive postoperative adjuvant treatment, such as chemoradiotherapy. (4) Follow-up: 4 patients were followed up for 12-31 months. During follow-up, 4 patients were in good condition, and 1 with transient fever was relieved by conservative treatment. Levels of tumor marker in 4 patients were normal, results of enhanced CT scan showed no signs of tumor recurrence and intrahepatic bile duct dilatation. Conclusion After precisely evaluating the tumor extension among segmental bile duct, single perihilar resection or combined with central segmentectomy can effectively cure hilar cholangiocarcinoma. Key words: Biliary neoplasms, hilar; Perihilar resection; Segmental bile duct