Surgical Treatment Of Hilar Cholangiocarcinoma Research Articles

Correction: Surgical treatment of hilar cholangiocarcinoma: retrospective analysis

Correction: Surgical treatment of hilar cholangiocarcinoma: retrospective analysis

Surgical treatment of hilar cholangiocarcinoma: retrospective analysis.

Achieving a better prognosis for patients and reducing the risk of complications are primary considerations in surgical decisions for hilar cholangiocarcinoma. A retrospective analysis of the authors' clinical practice outcomes in the surgical management of patients with hilar cholangiocarcinoma following the planned-hepatectomy surgical treatment programme between 2009 and 2018. Some 473 patients were included, of whom 127 (26.8 per cent) underwent bile duct tumour resection alone, 44 (9.3 per cent) underwent bile duct tumour resection combined with restrictive hepatectomy, and 302 (63.8 per cent) underwent bile duct tumour resection combined with extensive hepatectomy. R0 resection was achieved in 82.2 per cent and the postoperative complication rate was similar between the different operations. The 5-year survival rates after surgery were 37.0, 37.3, and 28.4 per cent in the bile duct tumour resection alone, restrictive hepatectomy, and extensive hepatectomy groups respectively, with no statistically significant differences. As TNM staging progressed, the 1-5-year cumulative survival rate for the patients in the three groups showed a significant downward trend. In the setting of a high-volume centre, a planned-hepatectomy surgical treatment programme helps to strike a better balance between achieving radical tumour resection for hilar cholangiocarcinoma and reasonable control of the extent of surgical damage.

Prediction and prevention of severe complications following radical surgical treatment of hilar cholangiocarcinoma

This literature review highlights the recent advances in the prevention and prognosis of purulent-septic complications, post-resection liver failure, and other severe postoperative complications following the surgical treatment of hilar cholangiocarcinoma. The data obtained from the analysis of the recent scientific publications indicate the relevance of this problem. Research should be prioritized to formulate combined methods that can assess the risk of perioperative complications.

Impact of body mass index on postoperative outcomes in patients undergoing radical resection for hilar cholangiocarcinoma.

Body mass index (BMI) has been widely used as a prognostic indicator. The association between preoperative BMI and postoperative morbidity in patients with hilar cholangiocarcinoma (HCCA) has not been proved. This study aimed to identify the association between preoperative BMI and postoperative morbidity following radical resection of HCCA. Patients were divided into three groups according to preoperative BMI: low BMI (≤18.4 kg/m2 ), normal BMI (18.4-24.9 kg/m2 ), and high BMI (≥24.9 kg/m2 ). Baseline characteristics, operative variables, postoperative 30-day mortality, and morbidity were compared. Risk factors associated with postoperative morbidity were assessed using univariable and multivariable logistic analyses. Among 260 patients, 183 (70.4%) had normal BMI, 32 (12.3%) had low BMI, and 45 (17.3%) had high BMI. Compared to the patients with normal-BMI, both low and high BMI patients exhibited a significantly higher postoperative morbidity (87.5% and 82.2% vs 63.9%, P = .019 and P = .025, respectively). Additionally, the multivariable analysis revealed that both low and high BMI patients remained independently associated with an increased risk of postoperative morbidity. (OR: 3.707, 95% CI: 1.080-12.725, P = .037; and OR: 2.858, 95% CI: 1.167-7.002, P = .022, respectively). BMI is an independent risk factor for higher postoperative morbidity in patients who undergo surgical treatment of hilar cholangiocarcinoma.

Application of multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of bile hilar duct lake in the operation of hilar cholangiocarcinoma.

Hilar cholangiocarcinoma is the most common malignant tumor of the extrahepatic bile duct. Until now, radical resection has been the most effective method for the long-term survival of patients with the disease. However, many problems have emerged in the field of hepatobiliary surgery for a long time, including complex surgical procedures, low resection rate, and postoperative complications. We have adopted the "multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of a bile duct lake" technique in the treatment of hilar cholangiocarcinoma since 2008, and obtained satisfactory short- and long-term results. To examine the feasibility of the application of multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of a bile duct lake in the operation of hilar cholangiocarcinoma. A retrospective analysis was performed for the clinical data, surgical methods, and results of 76 patients with hilar cholangiocarcinoma who were treated with hilar bile duct lake-forming multiple Roux-en-Y hepaticojejunostomy reconstruction at Gansu Provincial Hospital. In all 76 cases, the operation was successful and no operative death occurred. The mean (range) operation time was 215.4 ± 53.5 min (124-678 min), and the amount of bleeding during the operation was 428.2 ± 63.8 mL (240-2200 mL). The overall 1-year survival rate was 78.9%, and the 3-year survival rate was 32.8%. The multiple Roux-en-Y hepaticojejunostomy reconstruction technique with formation of a bile duct lake is safe and effective for the surgical treatment of hilar cholangiocarcinoma.

Analysis of the curative effect and prognosis factors of surgical treatment for hilar cholangiocarcinoma

Objective To exlore and analyze the curative effect and pognostic factors of surgical treatment for hilar cholangiocarcinoma. Methods The clinical data and prognosis of 92 patients with hilar cholangiocarcinoma admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2010 to January 2018 were retrospectively analyzed. There were 58 males and 34 females, with an age range of 35-81 years and average age of 61.3 years. Among them, 50 patients underwent radical resection of tumors (radical operation group), and 42 patients were discussed to undergo radical operation before operation, but only palliative resection of tumors or simple biliary drainage (palliative operation group) were performed because of the high location of tumors or distant metastasis during operation. Of the 50 patients who received radical surgery, 27 underwent simple perihepatic portectomy (perihepatic hilar resection group), and 23 underwent combined hepatic lobectomy (extended hepatectomy group). The incidence of perioperative complications, perioperative mortality and long-term survival rate of all patients were collected. The data of clinical cases included in the study were analyzed by univariate and multivariate analysis, and the relationship between perioperative mortality and prognosis survival time was discussed. The measurement data that accord with normal distribution were expressed by (Mean±SD). The comparison between the two groups was performed by t-test, the comparison between multiple groups was performed by one-way ANOVA; Measurement data with non-normal distribution were described as M(P25, P75), and comparison between groups was done using Mann-Whitney U test. The comparison between counting data groups was performed by chi-square test. Results Ninety-two patients included in this study successfully completed the operation. One patient died during the perioperative period, with a mortality rate of 1.09%. The incidence of complications was 35.87%. Biliary tract infection and bile leakage were the most common complications. The incidence of complications was 14.13%(13/92) and 9.78%(9/92) respectively. The survival time of patients in the radical operation group 34.23(13.00, 52.25) months was significantly different from that in the palliative operation group 4.75(2.88, 7.25) months (Z=-6.708, P=0.000). There was no significant difference in the survival time between the extended hepatectomy group 33.87(13.00, 56.00) months and the simple perihepatectomy group 34.54(13.00, 51.00) months (Z=-0.156, P=0.876). Univariate analysis showed that the factors related to the prognosis of hilar cholangiocarcinoma were preoperative history of calculi, tumor size, preoperative highest serum total bilirubin level, preoperative CA19-9 level, surgical modality and tumor differentiation(HR=0.200, 2.692, 2.942, 4.350, 3.740, 0.198; 95%CI: 0.043-0.938, 0.995-7.283, 1.022-8.469, 1.174-16.114, 1.229-11.382, 0.049~0.806, P<0.05). Multivariate analysis showed that tumor size, tumor differentiation and surgical modality were related to hilar cholangiocarcinoma. Surgical prognosis of patients with cholangiocarcinoma was significantly correlated(OR=1.034, 6.444, 12.527; 95%CI: 1.007-1.062, 1.012-41.037, 3.187-49.243, P<0.05). Conclusions Radical resection is an effective way to improve the survival of patients with hilar cholangiocarcinoma. The effective grasp of surgical indications can improve the overall treatment prognosis. Key words: Bile duct neoplasms; Surgical procedures, operative; Prognosis; Treatment outcome; Complications

Progress in surgical treatment of hilar cholangiocarcinoma

Hilar cholangiocarcinoma is a dread disease for humankind due to its high level of malignant, quick metastatic, and high mortality rate. Some patients get treated at the stage of obstructive jaundice, when the intestines are mostly or even completely obstructed, whom can not be radically treated since it can only lead to many complications and a low level of life quality. Despite the various ways of curing this disease, we will talk about the latest progress of surgical excision, palliative treatment, as well as liver transplantation in the eyes of surgical skills. This essay aims to summarize the latest treatment for hilar cholangiocarcinoma in the area of surgery, updating our knowledges, as a way of upgrading our skills and transforming our minds, so as to raise the life quality of our patients by avoiding complications. At the same time, it can provide some ideas for further research in this area. Besides, the paper sheds light on the current treatment of the disease by pointing out some questions on clinical works, which also focuses on lowering the death rate and raising the life quality of our patients. Key words: Bile duct neoplasms; Surgical procedures, operative; Treatment outcome

Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of T stages in hilar cholangiocarcinoma.

Background: The purpose of this study was to evaluate the relationship between preoperative inflammatory markers (neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR)) and different American Joint Committee on Cancer (AJCC) T stages in patients with hilar cholangiocarcinoma.Methods: A total of 101 patients who underwent surgical treatment for hilar cholangiocarcinoma between 2003 and 2014 in Peking Union Medical College Hospital were retrospectively analyzed. Receiver-operating curves were used to calculate optimal cutoff values for the NLR and the PLR. Univariate and multivariate analyses were used to identify whether the NLR and PLR can independently predict different AJCC T stages.Results: Multivariate analysis showed that higher NLR and PLR independently predicted advanced AJCC T stages (OR 3.74, 95% CI 1.09–12.83, P=0.036; and OR 7.86, 95% CI 2.25–27.43, P=0.001, respectively). At a threshold of 2.75, the NLR was 75.9% sensitive and 66.7% specific for different AJCC T stages; at a threshold of 172.25, the PLR was 65.5% sensitive and 80.6% specific.Conclusion: Preoperative NLR and PLR can be used as independent predictors of different AJCC T stages in patients with hilar cholangiocarcinoma.

Relevance of Preoperative Hyperbilirubinemia in Patients Undergoing Hepatobiliary Resection for Hilar Cholangiocarcinoma.

Preoperative hyperbilirubinemia is known to increase the risk of mortality and morbidity in patients undergoing resection for hilar cholangiocarcinoma. The aim of this study was to characterize the associations between the preoperative bilirubin concentration and the risk of postoperative mortality and severe complications to guide decision-making regarding preoperative biliary drainage. Eighty-one patients undergoing liver and bile duct resection for hilar cholangiocarcinoma between 2005 and 2015 were analyzed retrospectively. Postoperative mortality and severe complications, defined as a Clavien–Dindo grade of ≥III, were the primary and secondary outcome measures, respectively. The severe postoperative complications and mortality rates were 28.4% (23/81) and 11.1% (9/81), respectively. Patients with preoperative biliary drainage had significantly lower bilirubin concentrations (p = 0.028) than did those without. The preoperative bilirubin concentration was a risk factor of postoperative mortality (p = 0.003), with an optimal cut-off of 6.20 mg/dL (c-statistic = 0.829). The preoperative bilirubin concentration was a risk factor of severe morbidity (p = 0.018), with an optimal cut-off of 2.48 mg/dL (c-statistic = 0.662). These results indicate that preoperative hyperbilirubinemia is a major risk factor of negative early postoperative outcomes of patients who undergo surgical treatment for hilar cholangiocarcinoma and may aid in decision-making with respect to preoperative biliary drainage.

Analysis of prognostic factors in the surgical treatment of hilar cholangiocarcinoma

Objective To analyze the prognostic factors in the surgical treatment of hilar cholangiocarcinoma. Methods The retrospective case-control study was conducted. The clinicopathological data of 93 patients [61 males and 32 females, age (64±8)years with the range of 43-84 years] with hilar cholangiocarcinoma who underwent surgical treatments in the General Hospital of the Northern Theater from January 2010 to December 2017 were collected. According to preoperative different staging and intraoperative exploration of hilar cholangiocarcinoma, corresponding operations were performed. Observation indicators: (1) surgical treatment situations; (2) tumor typing, staging and degree of differentiation: ① tumor typing and staging, ② degree of tumor differentiation; (3) follow-up situations; (4) analysis of prognostic factors: ①univariate analysis, ②multivariate analysis; (5) subgroup analysis. Follow-up using outpatient examination and telephone interview was performed to detect survival time and survival rate of patients up to December 31, 2017. Kaplan-Meier method was used to calculate survival time and survival rate and to draw survival curves. Survival situations were analyzed by Log-rank test. The univariate analysis and multivariate analysis were performed using the Log-rank test and COX proportional hazard model respectively. Results (1) Surgical treatment situations: 93 patients underwent surgical treatments, including 51 undergoing radical resection, 23 undergoing palliative resection, 16 undergoing internal biliary drainage or external drainage, 3 undergoing abdominal laparotomy and intraoperative biopsy. (2) Tumor typing, staging and degree of differentiation. ① Tumor typing and staging: of the 93 patients with hilar cholangiocarcinoma, Bismuth-Corlette type Ⅰ, Ⅱ, Ⅲa, Ⅲb and Ⅳ were detected in 26, 22 , 9, 18 and 18 patients. TNM stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were detected in 7, 34, 22 and 30 patients, Mayo Clinic stage 1, 2, 3, 4 were detected in 20, 19, 51 and 3 patients. ② Degree of tumor differentiation: results of pathological examination showed 16 of 93 patients with highly differentiated adenocarcinoma, 35 with moderately differentiated adenocarcinoma, 37 with poorly differentiated adenocarcinoma, 4 with mucinous adenocarcinoma and 1 with papillary adenocarcinoma. (3) Follow-up situations: 93 patients were followed up for 6-36 months, with a median time of 24 months. The survival time of 93 patients was (21.4±2.1)months and the 1-, 2-, 3-year overall survival rates were 62.2%, 34.9% and 17.1%, respectively. (4) Analysis of prognostic factors: ① results of univariate analysis showed that preoperative level of TBil, preoperative level of CA19-9, preoperative level of CA24-2, surgical methods, lymph node metastasis, vascular invasion, TNM staging, Mayo Clinic staging, degree of tumor differentiation were related factors affecting prognosis of patients with hilar cholangiocarcinoma (χ2=6.321, 7.357, 6.590, 22.088, 11.173, 22.914, 23.326, 25.966, 39.512, P 0.05). Of the 35 patients with vascular invasion, the overall survival time was (7.0±2.0)months and 1-, 2-, 3-year survival rates were 14.5%, 7.3%, 0 respectively in 18 with portal vein invasion only, (10.0±2.1)months and 37.5%, 18.8%, and 18.8% respectively in 8 with hepatic artery invasion, showing no statistically significant difference between the two groups (χ2=0.905, P>0.05). Conclusions Preoperative level of TBil, preoperative level of CA19-9, surgical procedures, vascular invasion and degree of tumor differentiation are independent prognostic factors for patients with hilar cholangiocarcinoma. Radical resection can prolong the survival time of patients compared with other surgical treatments. Key words: Hilar cholangiocarcinoma; Surgical procedures, operative; Tumor typing; Tumor staging; Degree of tumor differentiation; Prognosis analysis

Treatment of resectable hilar cholangiocarcinoma: a choice of right- or left-side hepatectomy

Introduction: Radical resection is the only curative treatment for patients with hilar cholangiocarcinoma. Some have argued that left-side hepatectomy has worse prognosis regarding its contiguous anatomical relationship between hepatic inflow and biliary confluence, otherwise right-side hepatectomy has worse surgical morbidity and mortality. This study aimed to compare the surgical morbidity and long-term outcome between right- and left-side hepatectomy to help the decision of which side to be resected in the surgical treatment of hilar cholangiocarcinoma. Method: A total of 83 patients attempting curative resection for hilar cholangiocarcinoma at the Korea University Medical Center between 2010 and 2017 were considered for this study. After excluding patients who did not undergo curative-intent surgery or hepatectomy, 57 patients undergoing right- or left-side hepatectomy were finally enrolled for analysis. Prospectively collected clinicopathologic characteristics, perioperative outcomes, and survival were evaluated. Result: Right-side hepatectomy (RH) and left-side hepatectomy (LH) were performed for 33 and 24 patients, respectively. The proportion of R0 resection was comparable between both groups (75.8% for RH group and 75.0% for LH group, p=0.948). Posthepatectomy liver failure was significantly more prevalent in the RH group than the LH group (75.7% vs. 12.5%, p<0.001). 90-day mortality did not differ between both groups (9.1% vs. 4.2%, p=0.631). The 5-year overall survival rate was 37.7% for the RH group; and 41.9% for the LH group (p=0.500). The 5-year recurrence-free survival rate was 26.3% for the RH group; and 33.9% for the LH group (p=0.580). Conclusion: Posthepatectomy liver failure was more prevalent in the RH group than the LH group, but it did not affect the 90-day mortality. It is recommended to perform surgical resection only according to the possibility to achieve radical resection, regardless of right- or left-side hepatectomy.

Actual 5-Year Survivors After Surgical Resection of Hilar Cholangiocarcinoma.

The prevalence and characteristics of actual 5-year survivors after surgical treatment of hilar cholangiocarcinoma (HC) have not been described previously. Patients who underwent resection for HC from 2000 to 2015 were analyzed through a multi-institutional registry from 10 U.S. academic medical centers. The clinicopathologic characteristics and both the perioperative and long-term outcomes for actual 5-year survivors were compared with those for non-survivors (patients who died within 5years after surgery). Patients alive at last encounter who had a follow-up period shorter than 5years were excluded from the study. The study identified 257 patients with HC who underwent curative-intent resection with an actuarial 5-year survival of 19%. Of 194 patients with a follow-up period longer than 5years, 23 (12%) were 5-year survivors. Compared with non-survivors, the 5-year survivors had a lower median pretreatment CA 19-9 level (116 vs. 34 U/L; P = 0.008) and a lower rate of lymph node involvement (42% vs. 15%; P = 0.027) and R1 margins (39% vs. 17%; P = 0.042). However, the sole presence of these factors did not preclude a 5-year survival after surgery. The frequencies of bile duct resection alone, major hepatectomy, caudate lobe resection, portal vein or hepatic artery resection, preoperative biliary sepsis, intraoperative blood transfusion, serious postoperative complications, and receipt of adjuvant chemotherapy were comparable between the two groups. One in eight patients with HC reaches the 5-year survival milestone after resection. A 5-year survival can be achieved even in the presence of traditionally unfavorable clinicopathologic factors (elevated CA 19-9, nodal metastasis, and R1 margins).

The safety and effect of transhepatic hilar approach for the treatment of bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma

Objective: To compare the efficiency between the transhepatic hilar approach and conventional approach for the surgical treatment of Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma. Methods: There were 42 consecutive patients with hilar cholangiocarcinoma of Bismuth type Ⅲ and Ⅳ who underwent surgical treatment at Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2008 to December 2013.The transhepatic hilar approach was used in 19 patients and conventional approach was performed in 23 patients.There were no differences in clinical parameters between the two groups(all P>0.05). The t-test was used to analyze the measurement data, and the χ(2) test was used to analyze the count data.Kaplan-Meier analysis was used to analyze the survival period.Multivariate COX regression analysis was used to analyze the prognosis factors. Results: Among the 19 patients who underwent transhepatic hilar approach, 3 patients changed the operative planning after reevaluated by exposing the hepatic hilus.The intraoperative blood was 300(250-400)ml in the transhepatic hilar approach group, which was significantly less than the conventional approach group, 800(450-1 300)ml(t=4.276, P=0.00 1), meanwhile, the R0 resection rate was significantly higher in the transhepatic hilar approach group than in the conventional approach group(89.4% vs. 52.2; χ(2)=6.773, P=0.009) and the 3-year and 5-year cumulative survival rate was better in the transhepatic hilar approach group than in the conventional approach group(63.2% vs. 47.8%, 26.3% vs. 0; χ(2)=66.363, 127.185, P=0.000). On univariate analysis, transhepatic hilar approach, intraoperative blood loss, intraoperative blood transfusion, R0 resection and lymph node metastasis were significant risk factors for patient survival(all P<0.05). On multivariate analysis, use of transhepatic hilar approach, intraoperative blood loss, R0 resection and lymph node metastasis were significant independent risk factors for patient survival(all P<0.05). Conclusion: The transhepatic hilar approach is the preferred technique for surgical treatment for hilar cholangiocarcinoma because it can improve accuracy of surgical planning, safety of operation, R0 resection rate and survival rate compared with the conventional approach.

Clinical application of combined hepatic artery resection and reconstruction in surgical treatment for hilar cholangiocarcinoma

Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group(n=174), portal vein reconstruction group (n=47), hepatic artery reconstruction group (n=24), palliative group(n=27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD-t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly (P<0.05). However, the rate of postoperative complications of the hepatic artery reconstruction group and the routine radical operation group and the portal vein reconstruction group were 62.5%(15/24), 55.3%(96/174) and 51.5%(24/47), respectively. There was no significant difference among them (P>0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly (P<0.05). The presented data also indicate that hepatic artery resection prolongs survival time comparing with patients undergoing palliative therapy for hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and reconstruction is a protective factor compare with palliative therapy (RR=0.38, 95%CI: 0.22-0.67). The significant reason for shorter survival time is a positive correlation between hepatic artery invasion and lymph node metastasis. Conclusion: Hepatic artery resection and reconstruction has beneficial impact on oncologic long-term outcome in patients with advanced stage hilar cholangiocarcinoma.

Preoperative biliary drainage on the effect of surgical treatment for hilar cholangiocarcinoma

Objective To investigate the preoperative biliary drainage on the effect of surgical treatment for hilar cholangiocarcinoma patients. Methods A total of 52 hilar cholangiocarcinoma patients who underwent resection operation in Renmin Hospital of Wuhan University from January 2005 to December 2015 were divided into preoperative biliary drainage group (24 cases) and non-preoperative biliary drainage group (28 cases). To compare the operation time, intraoperative blood loss, hospital stay, perioperative changes in liver function, and incidence of postoperative complications, tumor recurrence rate, 1-, 3-, and 5-year survival rate and some other indicators. The data was analyzed using SPSS 19.0 software.The patients of two groups were followed up by telephone, out-patient review and hospital examination. Patients were followed up for 8-60 monthes. Results The hospital stay for biliary drainage group was longer than that in non-preoperative biliary drainage group and the difference was statistically significant(P 0.05). Alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin in preoperative biliary drainage group before biliary drainage were(98.0±51.7) U/L, (94.2±44.2) U/L, (177.5±64.1) μmol/L and (160.2±61.9) μmol/L, respectively, and after biliary drainage were (71.2±13.8) μmol/L, (60.0±12.1) μmol/L, (93.5±20.7) μmol/L and (76.3±18.1) μmol/L, respectively. The differences of the above parameters before and after biliary drainage were statistically significant (P 0.05). The follow-up patients of biliary drainage group were 21 cases and the follow-up patients of non-preoperative biliary drainage group were 25 cases. The differences of 1-, 3-, and 5-year survival rate between the two groups were not statistically significant (P>0.05). Conclusions Preoperative biliary drainage for hilar cholangiocarcinoma patients may improve the liver function to a certain extent. However, preoperative biliary drainage cannot improve the prognosis of the hilar cholangiocarcinoma patients. Therefore preoperative biliary drainage is not suggested for patients with good general conditions. Key words: Bile duct neoplasms; Hilar cholangiocarcinoma; Jaundice; Therapies, investigational

Liver parenchyma transection-first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes.

Although hemihepatectomy with total caudate lobectomy (hemiHx-tc) is essential for the surgical treatment of hilar cholangiocarcinoma, the advantage of an anterior approach for hemiHx-tc has not been fully discussed technically; the significance of an anterior approach without liver mobilization for preventing infectious complications also remains unknown. The liver parenchyma transection-first approach (Hp-first) technique is an early transection of the hepatic parenchyma without mobilization of the liver that utilizes a modified liver-hanging maneuver to avoid damaging the future remnant liver. Between May 2010 and August 2016, a total of 40 consecutive patients underwent surgery for hilar cholangiocarcinoma. Of these, 19 patients underwent a conventional hemihepatectomy with total caudate lobectomy (cHx), while 21 patients received a Hp-first. The patients in the Hp-first group had significantly less intraoperative blood loss (P < 0.001) and blood transfusion (P < 0.001), a lower incidence of postoperative hyperbilirubinemia (p = 0.023), a lower incidence of liver failure (p = 0.038), a lower hospital death rate (p = 0.042), and a better 2-year disease-free survival rate (p = 0.010) than those in the cHx group. The liver parenchyma transection-first approach is the preferred technique for hemiHx-tc in hilar cholangiocarcinoma because it resulted in improved surgical outcomes as compared with the conventional approach.

Surgical treatment of 56 patients with hilar cholangiocarcinoma in a single center

Objective To study the safety and efficacy of surgical treatment for hilar cholangiocarcinoma (HC). Methods We retrospectively analyzed the clinical data of 56 patients with HC who underwent resection at the Beijing YouAn Hospital, Capital Medical University, from January 2010 to July 2015. The patients were divided into two groups according to the types of operations: the minor hepatectomy group (n=12) and the major hepatectomy group (n=44). The postoperative complications, mortality and long-term survival rates were compared and the clinical data were analyzed using uni- and multivariate analyses to examine the significant factors of survival. Results (1) The morbidity rates of the two groups were 33.3% and 63.6%, respectively, with the latter group being significantly higher than the former group; (2) The 1-and 3-year overall survival rates were 60% and 15% in the minor liver resection group and 64% and 15% in the major resection group, and there was no significant difference between the two groups (P>0.05). The median survival was 16 months; (3) The median survival of R0 resection was significantly longer than the R1/R2 resection group (22 months vs 10 months, P<0.05); (4) Age, preoperative CA19-9 level, vascular invasion, surgical margin, tumor differentiation and nodular metastasis were significantly correlated with prognosis on univariate analysis. Multivariate analysis showed surgical margin and tumor differentiation to be significant prognostic factors. Conclusions R0 resection obviously prolonged survival of HC patients, and histopathology negative surgical margin should be emphasized. With R0 resection, minor liver resection significantly reduced postoperative complications and mortality in selected patients. Key words: Hilar cholangiocarcinoma; Minor hepatectomy; Postoperative complications; Resection; Survival rate

Surgical Treatment of Hilar Cholangiocarcinoma (Review)

Surgical Treatment of Hilar Cholangiocarcinoma (Review)

Actual Long-Term Survival Outcome of 403 Consecutive Patients with Hilar Cholangiocarcinoma.

Despite aggressive surgical resection, prognosis of patients with hilar cholangiocarcinoma is still unsatisfactory. There were limited data about actual long-term survival outcome. This study was designed to explore actual long-term survival outcome of hilar cholangiocarcinoma after surgical treatment, and to investigate the characteristics of patients with actual long-term survival. The study cohort consisted of 403 consecutive patients with at least 5-year follow-up after surgical treatment for hilar cholangiocarcinoma at Seoul National University Hospital between 1991 and 2010. Prognostic factors were analyzed with Cox proportional hazard models, and the effect of adjuvant treatment was evaluated by propensity score analysis. Of all patients, R0 resection rate was 41.2 and 63.8% among intended curative resection. Adjuvant therapy was performed in 48.8% after curative surgery. Actual 5-year overall survival (OS) rate was 18.9, and 30.1% after R0 resection. Actual 5-year disease-free survival rate was 25.8% after resection. Adjuvant treatment improved prognosis in patients with positive metastatic lymph nodes (median OS 21.9 vs. 11.5months, p=0.003). Overall recurrence rate was 55.0%, and distant metastasis (39.7%) was more frequent than loco-regional recurrence (20.8%). Lymph node metastasis (p=0.021) and poor histologic grade (p<0.001) were independent prognostic factors after curative resection. Patients who survived more than 5years had less lymph node metastasis (p=0.025), poor histologic differentiation (p=0.010), R2 resection (p=0.040), and recurrence (p<0.001). Actual 5-year OS rate after R0 resection of hilar cholangiocarcinoma is 30.1%. Adjuvant treatment could be beneficial in patients with lymph node metastasis.

Клинико-морфологические факторы прогноза при воротной холангиокарциноме

Клинико-морфологические факторы прогноза при воротной холангиокарциноме