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

01-07-2010 | Topics

Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience

Authors: Tsuyoshi Igami, Hideki Nishio, Tomoki Ebata, Yukihiro Yokoyama, Gen Sugawara, Yuji Nimura, Masato Nagino

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

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Abstract

Objective

To review our surgical experience with hilar cholangiocarcinoma in the “new era.”

Methods

The medical records of 428 patients with hilar cholangiocarcinoma who underwent treatment between 2001 and 2008 at the First Department of Surgery, the Nagoya University Hospital, were retrospectively reviewed.

Results

Of the 428 patients, 298 (70%) underwent surgical resection (R0, n = 220; R1, n = 70; R2, n = 8). Portal vein resection was performed in 111 (37%) patients, and hepatic artery resection was performed in 53 (18%) patients. Several different types of postoperative complications occurred in a total of 129 (43%) patients and led to 6 (2%) deaths. Of the 298 resected tumors, 206 (69%) were extrahepatic type tumors, and the remaining 92 (31%) were intrahepatic type tumors. Using the Bismuth classification criteria, we identified 15 (5%) type I, 21 (7%) type II, 120 (40%) type III, and 142 (48%) type IV tumors. The overall 1-, 3-, and 5-year survival rates for all 298 patients were 77, 49, and 42%, respectively. The survival rates were highest among the 197 patients with pM0 disease who underwent R0 resection. Patients in this subgroup had a 5-year survival rate of 52%. The 5-year overall survival rate for the 55 patients with pM0 disease who underwent R1 resection was 32%. The survival rate for patients who had pM1 disease and/or underwent R2 resection was the worst of all the subgroups, but was nonetheless significantly better than that of patients with unresectable tumors. The survival rate for patients who underwent vascular resection and reconstruction was unexpectedly better, with 5-year survival of >20%.

Conclusions

The surgical approach to hilar cholangiocarcinoma has become more challenging in the new era. Nevertheless, surgical outcomes have been improved, with decreased morbidity and mortality rates being observed. Long-term survival has also steadily improved. These findings indicate that biliary surgeons should use an aggressive surgical strategy to treat this intractable disease.
Literature
1.
Launois B, Terblanche J, Lakehal M, Catheline JM, Bardaxoglou E, Landen S, et al. Proximal bile duct cancer. High respectability rate and 5-year survival. Ann Surg. 1999;230:266–75.CrossRefPubMed
2.
Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, King N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–19.CrossRefPubMed
3.
Lee SG, Lee YJ, Park KM, Hwang S, Min PC. One hundred and eleven liver resections for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2000;7:135–41.CrossRefPubMed
4.
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;232:166–74.CrossRefPubMed
5.
Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz J, et al. Staging, respectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234:507–19.CrossRefPubMed
6.
Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome pf extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238:73–83.CrossRefPubMed
7.
Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S, et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003;238:84–92.CrossRefPubMed
8.
Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg. 2004;240:95–101.CrossRefPubMed
9.
Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg. 2006;244:240–7.CrossRefPubMed
10.
Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience. HPB. 2005;7:259–62.CrossRefPubMed
11.
Sugiura T, Nishio H, Nagino M, Senda Y, Ebata Y, Yokoyama Y, et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg. 2008;32:1478–84.CrossRefPubMed
12.
Senda Y, Nishio H, Oda K, Yokoyama Y, Ebata T, Igami T, et al. Value of multidetector row CT in the assessment of longitudinal extension of cholangiocarcinoma-correlation between MDCT and microscopic findings. World J Surg. 2009;33:1459–67.CrossRefPubMed
13.
Nagino M, Nimura Y, Kamiya J, Kondo S, Kanai M. Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology. 1996;200:559–63.PubMed
14.
Nagino M, Nimura Y, Kamiya J, Kondo S, Uesaka K, Kin Y, et al. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar cholangiocarcinoma. Surgery. 1995;117:677–81.CrossRefPubMed
15.
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;243:364–72.CrossRefPubMed
16.
Kamiya S, Nagino M, Kanazawa H, Komatsu S, Mayumi T, Takagi K, et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg. 2004;239:510–7.CrossRefPubMed
17.
Kanazawa H, Nagino M, Kamiya S, Komatsu S, Mayumi T, Takagi K, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg. 2005;390:104–13.CrossRefPubMed
18.
Sugawara G, Nagino M, Nishio H, Ebata T, Takagi K, Asahara T, et al. Perioperative symbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg. 2006;244:706–14.CrossRefPubMed
19.
Ebata T, Kamiya J, Nishio H, Nagasaka T, Nimura Y, Nagino M. The concept of perihilar cholangiocarcinoma is valid. Br J Surg. 2009;96:926–34.CrossRefPubMed
20.
Nagino M, Nimura Y, Kamiya J, Kondo S, Kanai M, Miyachi M, et al. Preoperative management of hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 1995;2:215–23.CrossRef
21.
Ikeyama T, Nagino M, Oda K, Ebata T, Nishio H, Nimura Y. Surgical approach to Bismuth type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg. 2007;246:1052–7.CrossRefPubMed
22.
Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg. 2006;243:28–32.CrossRefPubMed
23.
Kitagawa Y, Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, et al. Lymph node metastasis from cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg. 2001;233:385–92.CrossRefPubMed
24.
Tojima Y, Nagino M, Ebata T, Uesaka K, Kamiya J, Nimura Y. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma. Ann Surg. 2003;237:201–7.CrossRefPubMed
25.
Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg. 1990;14:535–44.CrossRefPubMed
26.
Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, et al. Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg. 1991;78:727–31.CrossRefPubMed
27.
Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7.CrossRefPubMed
28.
Miyazaki M, Kato A Ito H, Kimura F, Shimizu H, Ohtsuka N, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery. 2007;141:581–8.CrossRefPubMed
29.
Ebata T, Watanabe H, Ajioka Y, Oda K, Nimura Y. Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg. 2002;89:1260–7.CrossRefPubMed
30.
Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991;38:170–5.PubMed
31.
Ebata T, Nagino M, Nishio H, Arai T, Nimura Y. Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg. 2007;14:131–5.CrossRefPubMed
32.
Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al., editors. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.
33.
Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. One hundred consecutive hepatobiliary resections for biliary malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery. 2005;137:148–55.CrossRefPubMed
34.
Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, Hayakawa N, et al. Complications of hepatectomy for hilar cholangiocarcinoma. World J Surg. 2001;25:1277–83.CrossRefPubMed
35.
Gerhards MF, Gulik TM, de Wit LT, Obertop H, Gouma DJ. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma—a single center experience. Surgery. 2000;127:395–404.CrossRefPubMed
36.
Sakamoto Y, Sano T, Shimada K, Kosuge T, Kimata Y, Sakuraba M, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbeck’s Arch Surg. 2006;391:203–8.CrossRef
Metadata
Title
Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience
Authors
Tsuyoshi Igami
Hideki Nishio
Tomoki Ebata
Yukihiro Yokoyama
Gen Sugawara
Yuji Nimura
Masato Nagino
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/s00534-009-0209-0

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