Surgical Outcome of Vascular Resection and Reconstruction for Perihilar Cholangiocarcinoma

Abstract

Introduction: Perihilar cholangiocarcinoma (pCCA) is an intractable malignancy and often involves the adjacent vasculature. To achieve radical resection, hepatectomy combined with vascular resection is required. This study aims to investigate short- and long-term outcome of vascular resection for pCCA. Methods: We retrospectively reviewed 201 consecutive patients with pCCA who underwent surgical resection between October 2013 to December 2018. The patients were grouped into the no vascular resection (NVR) (n=139) and vascular resection (VR) (n=62); PVR (n=47) and HAR with or without PVR (n=15). Results: The incidence of vascular resection in pCCA was 30.85%; PVR 23.38% and HAR 7.46%. The VR group had more postoperative major complications and 90-day mortality than the NVR group (28.9% vs 51.6%, p=0.002 and 7.9% vs 19.4%, p=0.029, respectively), but there was no difference between PVR and HAR group. The VR had a considerably greater number of advanced tumors than the NVR in terms of the AJCC staging classification. The VR had a worse median survival time than the NVR (14.8 vs 6.5 months; p=0.001), but there was no difference between the PVR and the HAR (6.5 vs 6.1 months; p=0.83). Positive resection margin, LN metastasis, and distant metastases were all significant prognostic factors in multivariable analysis. Conclusion: Patients with pCCA who had VR had worse short- and long-term outcomes than those who did not. The VR group, on the other hand, had a higher tumor grade than the NVR group, necessitating the utilization of a multidisciplinary team to treat them. Tabled 1EP03A-002CharacteristicsUnivariableMultivariableNMST (months)p-valueHR95%CIp-valueBismuth type0.0051.500.997-2.2650.052 1-316613.8 4326.5pT stage (AJCC 8th)0.0011.010.686-1.4960.949 pT 1,211115.2 pT 3,4879.0pN stage (AJCC 8th)<0.0012.241.469-3.401<0.001 pN 09822.9 pN 1/21005.2pM stage (AJCC 8th)<0.0012.441.235-4.8300.01 pM 018812.7 pM 1103.4Stage (AJCC 8th)<0.0011.230.718-2.1020.453 Stage 1,25227.0 Stage 3,41468.0Resection margin status<0.0012.892.006-4.161<0.001 Negative10624.5 Positive925.7PVR0.0011.260.875-1.8260.211 Absent14314.8 Present556.5HAR0.09 Absent18312.2 Present156.1 Open table in a new tab