Surgery for hilar cholangiocarcinoma: an Italian experience

Abstract

From January 1980 to June 1997 we treated 159 patients with carcinoma of the hepatic duct confluence. Seventy-five patients underwent surgical resection (overall resectability rate: 47.2%), and radical resection was attempted in 46 patients (radical resectability rate: 28.9%) classified in the first three stages of our staging system. Perioperative mortality was 10% (16 patients). The 5-year survival rate for 46 patients with curative resection was 17.5% with a median survival of 19 months. The 5-year survival rate for those patients who underwent combined caudate lobectomy (n = 17) was 25%, whereas the survival rate for those who did not was zero. The difference between these two groups' results was statistically significant. The importance of careful preoperative staging is stressed. Preoperative tests should be limited to investigations (ultrasound with Doppler scan, spiral computed tomography, percutaneous transhepatic cholangiography) supplying most information about intra- and extrabiliary diffusion of the tumoral mass. We conclude by highlighting the importance of resection as the only treatment potentially improving long-term survival. On the basis of these results, caudate lobectomy is always recommended in association with resectional treatment of the neoplasm.

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

“…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]. These results indicate that combined caudate lobe resection should be performed in most cases of hilar or upper bile duct carcinoma for increasing curative resection rate and better prognosis.…”

Surgical Palliative Drainage in Un-resectable Malignant Biliary Obstruction

“…Studies revealed that patients receiving surgical treatment have a longer survival and better quality of life compared to the patients underwent nonsurgical palliative therapies [12,13]. Despite main advantages of surgical bypass, high early postoperative morbidity and mortality and complications due to external biliary drainage such as fluid and electrolyte imbalance, loss of bile, dislocation and obstruction of external catheter have to be considered [14,15].…”

Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

“…1 These tumors are often difficult to manage surgically because of their proximity to and possible infiltration of the portal vein, hepatic artery, and the surrounding liver parenchyma, including the caudate lobe. Resection is currently favored by most experienced hepatobiliary surgeons because it accomplishes both tumor excision and restoration of bilioenteric flow.…”