Top

Journal of Hepato-Biliary-Pancreatic Sciences

Published in:

01-07-2010 | Topics

Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds

Authors: Alastair L. Young, K. Rajendra Prasad, Giles J. Toogood, J. Peter A. Lodge

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 4/2010

Abstract

Objective

Surgery for hilar cholangiocarcinoma (HCCA) remains challenging, with radical procedures thought to offer the best chance of long-term survival. Here we present our data for surgical resection of HCCA for the period 2001–2008.

Methods

A prospectively maintained database was interrogated to identify all resections. Clinico-pathological data were analyzed and assessed for impact on survival.

Results

51 patients were identified. Almost three-quarters required hepatic trisectionectomy. Overall survival was 76% at 1 year, 36% at 3 years and 20% at 5 years. When R0 resection was achieved, the 5-year survival was 40%. Portal vein resection, perineural invasion and T-stage were predictive of overall survival on univariate analysis. Only T-stage remained significant on multivariate analysis. Lymph node status predicted disease-free survival.

Conclusion

Radical surgery continues to offer the prospect of long-term survival for patients with HCCA. Earlier detection and referral to tertiary centers may allow more patients to have potentially curative surgical resections.

Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet. 2005;366:1303–14.CrossRefPubMed

Taylor-Robinson SD, Toledano MB, Arora S, Keegan TJ, Hargreaves S, Beck A, et al. Increase in mortality rates from intrahepatic cholangiocarcinoma in England and Wales 1968–1998. Gut. 2001;48(6):816–20.CrossRefPubMed

Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med. 1965;38:241–56.CrossRefPubMed

Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakamura H, et al. Gemcitabine-based adjuvant chemotherapy improves survival after aggressive surgery for hilar cholangiocarcinoma. J Gastrointest Surg. 2009;13(8):1470–9.CrossRefPubMed

Sagawa N, Kondo S, Morikawa T, Okushiba S, Katoh H. Effectiveness of radiation therapy after surgery for hilar cholangiocarcinoma. Surg Today. 2005;35:548–52.CrossRefPubMed

Witzigmann H, Berr F, Ringel U, Caca K, Uhlmann D, Schoppmeyer K, et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg. 2006;244(2):230–9.CrossRefPubMed

Young AL, Prasad KR, Adair R, Abu Hilal M, Guthrie JA, Lodge JP. Portal vein arterialization as a salvage procedure during left hepatic trisectionectomy for hilar cholangiocarcinoma. J Am Coll Surg. 2008;207(5):e1–6.CrossRefPubMed

International Union Against Cancer (UICC). TNM classification of malignant tumors. 6th ed. New York: Wiley; 2002.

Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ. Surgical management of hilar cholangiocarcinoma. Ann Surg. 2005;241(5):693–9.CrossRefPubMed

10.

Dinant S, Gerhards MF, Rauws EA, Busch OR, Gouma DJ, van Gulik TM. Improved outcome of resection of hilar cholangiocarcinoma (Klatskin tumor). Ann Surg Oncol. 2006;13(6):872–80.CrossRefPubMed

11.

Jarnagin WR, Bowne W, Klimstra DS, Ben-Porat L, Roggin K, Cymes K, et al. Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma. Ann Surg. 2005;241(5):703–12.CrossRefPubMed

12.

Mansfield SD, Barakat O, Charnley RM, Jaques BC, O’Suilleabhain CB, Atherton PJ, et al. Management of hilar cholangiocarcinoma in the North of England: pathology, treatment, and outcome. World J Gastroenterol. 2005;11(48):7625–30.PubMed

13.

Silva MA, Tekin K, Aytekin F, Bramhall SR, Buckels JA, Mirza DF. Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol. 2005;31(5):533–9.CrossRefPubMed

14.

Nimura Y. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro). HPB (Oxford). 2008;10(2):130–3.

15.

Laurent A, Tayar C, Cherqui D. Cholangiocarcinoma: preoperative biliary drainage (Con). HPB (Oxford). 2008;10(2):126–9.

16.

Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7(2):155–62.CrossRefPubMed

17.

Sakata J, Shirai Y, Wakai T, Nomura T, Sakata E, Hatakeyama K. Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma. World J Gastroenterol. 2005;11(44):7024–7.PubMed

18.

Abulkhir A, Limongelli P, Healey AJ, Damrah O, Tait P, Jackson J, et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg. 2008;247(1):49–57.CrossRefPubMed

19.

Nishio H, Hidalgo E, Hamady ZZ, Ravindra KV, Kotru A, Dasgupta D, et al. Left hepatic trisectionectomy for hepatobiliary malignancy: results and an appraisal of its current role. Ann Surg. 2005;242(2):267–75.CrossRefPubMed

20.

Halazun KJ, Al-Mukhtar A, Aldouri A, Malik HZ, Attia MS, Prasad KR, et al. Right hepatic trisectionectomy for hepatobiliary diseases: results and an appraisal of its current role. Ann Surg. 2007;246(6):1065–74.CrossRefPubMed

21.

Ogata S, Belghiti J, Farges O, Varma D, Sibert A, Vilgrain V. Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma. Br J Surg. 2006;93(9):1091–8.CrossRefPubMed

22.

Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243(3):364–72.CrossRefPubMed

23.

Tsao JI, Nimura Y, Kamiya J, Hayakawa N, Kondo S, Nagino M, et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience. Ann Surg. 2000;232(2):166–74.CrossRefPubMed

24.

Ito F, Cho CS, Rikkers LF, Weber SM. Hilar cholangiocarcinoma: current management. Ann Surg. 2009;250(2):210–8.CrossRefPubMed

25.

Hidalgo E, Asthana S, Nishio H, Wyatt J, Toogood GJ, Prasad KR, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience. Eur J Surg Oncol. 2008;34(7):787–94.PubMed

26.

Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience. HPB (Oxford). 2005;7(4):259–62.

27.

Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230(6):808–18.CrossRefPubMed

Title: Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds
Authors: Alastair L. Young
K. Rajendra Prasad
Giles J. Toogood
J. Peter A. Lodge
Publication date: 01-07-2010
Publisher: Springer Japan
Published in: Journal of Hepato-Biliary-Pancreatic Sciences / Issue 4/2010
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI: https://doi.org/10.1007/s00534-009-0203-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2010

Single HCC between 2 and 5 cm: the grey zone

Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience

Hepatocellular carcinoma: new options for image-guided ablation

Major hepatectomy for perihilar cholangiocarcinoma

Single HCC between 2 and 5 cm: the grey zone

Surgical technique: new advances for expanding indications and increasing safety in liver resection for HCC