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Surgical management of hilar cholangiocarcinoma
Journal article   Open access   Peer reviewed

Surgical management of hilar cholangiocarcinoma

Alan W Hemming, Alan I Reed, Shiro Fujita, David P Foley and Richard J Howard
Annals of surgery, Vol.241(5), pp.693-702
05/2005
DOI: 10.1097/01.sla.0000160701.38945.82
PMCID: PMC1357124
PMID: 15849505
url
https://doi.org/10.1097/01.sla.0000160701.38945.82View
Published (Version of record) Open Access

Abstract

To assess the surgical management of hilar cholangiocarcinoma over a time period when liver resection was considered standard management. Hilar cholangiocarcinoma remains a difficult challenge for surgeons. An advance in surgical treatment is the addition of liver resection to the procedure. However, liver resection in the setting of liver dysfunction caused by biliary obstruction can be associated with increased mortality. Between 1997 and 2004, 80 patients with hilar cholangiocarcinoma having surgery were reviewed. Fifty-three patients had attempted curative resections, 14 patients had palliative bypasses, while 13 patients had findings that precluded any further intervention. Twenty-three patients required portal vein resection and reconstruction to achieve negative margins, 3 of which also required reconstruction of the hepatic artery. Patients undergoing resection had a 9% operative mortality, with morbidity of 40%. Patients who demonstrated lobar hypertrophy preoperatively due to tumor involvement of the contralateral liver or induced with portal vein embolization (PVE) had a significantly lower operative mortality than those patients without hypertrophy. Median overall survival in patients resected was 40 months, with 5-year survival of 35%. Negative margins were achieved in 80% of cases and were associated with improved survival. Five-year survival in patients undergoing resection with negative margins was 45%. Combined liver and bile-duct resection can be performed for hilar cholangiocarcinoma with acceptable mortality, though higher than that for liver resections performed for other indications. The use of PVE in cases where hypertrophy of the remnant liver has not occurred preoperatively may reduce the risk of operative mortality.
 Bile Duct Neoplasms - surgery Liver - pathology Humans Middle Aged Cholangiocarcinoma - mortality Male Embolization, Therapeutic Portal Vein - surgery Hepatectomy Drainage Cholangiocarcinoma - pathology Cholangiocarcinoma - surgery Bile Duct Neoplasms - mortality Survival Analysis Aged, 80 and over Adult Bile Ducts, Intrahepatic Female Aged Bile Duct Neoplasms - pathology Hypertrophy

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