Significance of Vascular Resection and Reconstruction in Surgery for Hilar Cholangiocarcinoma: With Special Reference to Hepatic Arterial Resection and Reconstruction

Abstract

The aim of this study was to assess the efficacy of combined resection and reconstruction (CRR) of the hepatic artery (HA) in surgery for hilar cholangiocarcinoma (HC). Among 172 patients who underwent surgical resection for HC, the following three groups were defined according to the type of vascular reconstruction: VR(-) group, in which neither CRR of the portal vein (PV) nor HA was performed (n=74); VR-PV group, in which only CRR of the PV was required (n=54); and VR-A group, in which CRR of the HA was performed either with or without CRR of the PV (n=44). Clinicopathological variables and clinical outcomes were compared among the three groups. Although the VR-A group showed significantly more advanced disease than other groups, the R0 resection rate was comparable among the three groups (VR(-), 74%; VR-PV, 80%; VR-A, 80%). The 5-year disease-specific survival rate was also comparable among the three groups (VR(-), 45.6%; VR-PV, 51.2%; VR-A, 22.3%), but tended to be worse in the VR-A group than in the other groups. A similar trend was observed in morbidity rate. Lymph node metastasis was more frequent in the VR-A group (59%) than in the other groups (VR(-), 33.8%; VR-PV, 50%). In the VR-A group, lymph node metastasis (p=0.004) and adjuvant chemotherapy (p=0.006) were determined to represent independent prognostic factors for survival according to multivariate analysis. CRR of the HA was considered efficacious in selected patients; however, long-term outcomes of the VR-A group seem unsatisfactory. Treatments additional to surgery may be necessary in cases requiring CRR of the HA.