Long-Term Outcome of Extended Hemihepatectomy for Hilar Bile Duct Cancer With No Mortality and High Survival Rate

Abstract

Our strategy, which includes preoperative biliary drainage and portal embolization, led to a reduction in the risks associated with major hepatectomy for hilar bile duct cancer, and resulted in zero mortality. Surgeons should aim at complete clearance of the tumor with an adequate surgical margin to ensure optimal long-term survival.

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…In fact, combined caudate lobe resection is considered as a standard surgical procedure for these diseases in Japan. Japanese high volume centers in which combined caudate lobe resection is routinely performed report relatively high curative resection rate (59-87%) and 5 year survival rate (33-44%) [74,87,124,127,[142][143][144][145][146][147][148]. Several reports from other countries also showed the benefits of this procedure for hilar/upper bile duct carcinoma [149][150][151][152][153][154].…”

“…Several reports also showed that PVE enables surgical resection in cases that are initially considered as unresectable due to the shortage of future remnant liver volume [123]. However, the indication of PVE differs by institutions and no consensus exists [72,[123][124][125][126][127][128][129][130][131][132][133].…”

“…As the resection volume of liver is different in each case, the future remnant liver volume should be considered case by case for prediction of postoperative liver function [135]. The ICG retention rate at 15min (ICGR15) or other ICG clearance tests are usually used as indicators for liver function [87,124,127,136,137]. ICG clearance test should be performed after relief of jaundice and cholangitis.…”

A new prognostic scoring system using factors available preoperatively to predict survival after operative resection of perihilar cholangiocarcinoma

“…However, mortality and morbidity rates after surgical resection are 0-15% and 14-66%, respectively, which are rather high compared with other cancers. Five-year overall survival rates reported from high-volume centers ranged at 22 to 40% [1][2][3][4][5][6][7][8][9][10][11] . These findings indicate that only selected patients could achieve satisfactory beneficial effects from surgical treatment.…”

“…Surgical resection is the only treatment option to cure perihilar cholangiocarcinoma [1][2][3][4][5][6][7][8][9][10][11] . However, mortality and morbidity rates after surgical resection are 0-15% and 14-66%, respectively, which are rather high compared with other cancers.…”