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Surgery Today
Published in: Surgery Today 1/2016

01-01-2016 | Original Article

Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution

Authors: Ryota Higuchi, Takehiro Ota, Takehisa Yazawa, Hideki Kajiyama, Tatsuo Araida, Toru Furukawa, Tatsuya Yoshikawa, Ken Takasaki, Masakazu Yamamoto

Published in: Surgery Today | Issue 1/2016

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Abstract

Purpose

This study aimed to examine the changes in procedures for hilar cholangiocarcinoma (HC) surgery and patient survival following HC surgery over a 40-year period.

Methods

Between 1974 and 2014, 239 consecutive patients underwent surgery for HC. The changes in perioperative therapy and short- and long-term surgical outcomes were evaluated.

Results

The rates of major hepatectomy (in particular, right hepatectomy) and R0 resection significantly increased. Blood loss, transfusion rate, morbidity, and surgical mortality all significantly decreased. The 5-year disease-specific survival was 9.29 % (n = 38) in 1974–1988, 41.1 % (n = 88) in 1989–2003 and 55.6 % (n = 57) in 2004–2008 (p = 0.0001: 1974–1988 vs 1989–2003, p < 0.0001:1974–1988 vs 2004–2008, p = 0.076: 1989–2003 vs 2004–2008). According to a multivariate analysis, Bismuth classification IV (HR vs I, 2.86), period 1989–2003 (HR vs 1974–1988, 0.31), 2004–2008 (HR vs 1974–1988, 0.26), and R1 or R2 resection (HR vs R0, 2.22) were independent prognostic factors.

Conclusion

The surgical outcomes for HC over the 40-year period clearly improved as a result of aggressive surgery and progress in surgical techniques, perioperative management, and diagnostic tools.
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Metadata
Title
Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution
Authors
Ryota Higuchi
Takehiro Ota
Takehisa Yazawa
Hideki Kajiyama
Tatsuo Araida
Toru Furukawa
Tatsuya Yoshikawa
Ken Takasaki
Masakazu Yamamoto
Publication date
01-01-2016
Publisher
Springer Japan
Published in
Surgery Today / Issue 1/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-015-1119-1

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