Major Hepatic Resection for Hilar Cholangiocarcinoma

Abstract

Between 1979 and 1997, 46 consecutive patients had resection of hilar cholangiocarcinoma by major hepatectomy, bile duct resection, and regional lymphadenectomy. Main Outcome Measures: Overall survival and tumor recurrence were correlated to clinicopathological factors, operative morbidity, and mortality. Results: Twenty-five patients underwent left hepatectomy, 17 underwent right hepatectomy, and 4 had extended right hepatectomy. Eighteen patients underwent resection of segment 1. Negative (R0) resection margins were achieved in 37 patients (80%). The operative mortality rate was 9%, and the surgical morbidity rate was 52%. Actual 1-year, 3-year, and 5-year survival rates were 80%, 39%, and 26%, respectively. Factors adversely associated with patient survival rates included: male sex, lymph node metastases, tumor grade 3 or 4, elevated direct serum bilirubin level at diagnosis, elevated preoperative activated partial thromboplastin time, and more than 4 U of red blood cells transfused perioperatively. Tumor size and R0 resection approached significance for survival. Factors associated with tumor recurrence included: male sex, tumor grade 3 or 4, a low hemoglobin level both at diagnosis and preoperatively, and a low preoperative prothrombin time and low alkaline phosphatase level at diagnosis and preoperatively. Median time to recurrence was 3.6 years. Tumor recurrence was predominantly local and regional. Conclusions: The actual 5-year survival rate of 26% justifies major partial hepatectomy, bile duct resection, and regional lymphadenectomy for hilar cholangiocarcinoma. The high frequency of local and regional recurrence warrants investigation of adjuvant therapy.

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

“…En bloc resection of the tumor, including negative histological resection margins, is the only treatment method that results in the long-term survival of patients (2). However, despite hilar cholangiocarcinoma exhibiting slow growth and late metastasis, tumor invasion of the vital hilar structures often leads to a low rate of resectability (3). A study published by the Memorial Sloan-Kettering Cancer Centre revealed that the rate of radical excision of hilar cholangiocarcinoma is <30% (2).…”

Vascular complications after orthotopic liver transplantation after neoadjuvant therapy for hilar cholangiocarcinoma

“…[2][3][4][5][6] Liver transplantation alone is an equally poor treatment. Five-year survival was only 28% and recurrence was 51% in the large series reported by the Cincinnati Transplant Tumor Registry.…”

Prognostic Factors and Adjuvant Treatments for Surgically Treated Cancers of the Biliary Tract: A Multicentre Study of the Anatolian Society of Medical Oncology (ASMO)

“…We know that the prognoses of gall bladder tumors are worse than tumors in other localizations (Qu et al, 2012). According to our study, the prognoses of gall bladder In the literature, especially surgical border positivity and lymph node involvement are known to be the negative prognostic factors (Klempnauer et al, 1997;Rea et al, 2004;Tamandl et al, 2009;Sierzega et al, 2009). Lymph node dissection adds an important survival advantage in biliary system tumors as well as in other kinds of tumors.…”