Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 6/2014

01-06-2014 | Original Article

Surgical Outcome of Hilar Plate Resection: Extended Hilar Bile Duct Resection Without Hepatectomy

Authors: Takehiro Noji, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Eiichi Tanaka, Satoshi Hirano

Published in: Journal of Gastrointestinal Surgery | Issue 6/2014

Login to get access

Abstract

Background

We have done curative or palliative extended extrahepatic bile duct resection at the level of the hilar plate for selected patients with cholangiocarcinoma with hilar spreading, calling this procedure “hilar plate resection” (HPR), but the results of evaluating the clinical benefits of HPR for cholangiocarcinoma with hilar spreading have not been reported.

Patients and Methods

Fifty-two patients with cholangiocarcinoma underwent HPR: the curative procedure was performed in 28 patients (cHPR group) and the palliative in 24 patients (pHPR group). In the same period, 128 patients with cholangiocarcinoma underwent major hepatectomy with intrahepatic cholangiojejunostomy (Hx group). These groups were compared in terms of post-operative complications and survival.

Results

There were no significant differences in the rate of patients with post-operative complications and in post-operative hospital stay. The overall cumulative 5-year survival rates for each procedure (Hx group, cHPR group and pHPR group) were 40, 38 and 11 %, respectively. There was no significant difference between the Hx and cHPR groups in survival rates (p = 0.87).

Conclusion

In conclusion, HPR appears to be safe and feasible for selected patients with cholangiocarcinoma. However, the indications for HPR should be restricted.
Literature
1.
go back to reference 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. Annals of surgery. 2004;240(1):95-101. Epub 2004/06/24.PubMedCentralPubMedCrossRef 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. Annals of surgery. 2004;240(1):95-101. Epub 2004/06/24.PubMedCentralPubMedCrossRef
2.
go back to reference Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, et al. Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. Journal of hepato-biliary-pancreatic surgery. 2009;17(4):455-62. Epub 2009/10/13.CrossRef Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, et al. Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. Journal of hepato-biliary-pancreatic surgery. 2009;17(4):455-62. Epub 2009/10/13.CrossRef
3.
go back to reference Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K. No-touch resection of hilar malignancies with right hepatectomy and routine portal reconstruction. Journal of hepato-biliary-pancreatic surgery. 2009;16(4):502-7. Epub 2009/04/11.PubMedCrossRef Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K. No-touch resection of hilar malignancies with right hepatectomy and routine portal reconstruction. Journal of hepato-biliary-pancreatic surgery. 2009;16(4):502-7. Epub 2009/04/11.PubMedCrossRef
4.
go back to reference Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, et al. One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. Journal of hepato-biliary-pancreatic sciences. 2010;17(4):470-5. Epub 2009/11/26.PubMedCrossRef Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, et al. One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. Journal of hepato-biliary-pancreatic sciences. 2010;17(4):470-5. Epub 2009/11/26.PubMedCrossRef
5.
go back to reference Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Evolution of Surgical Treatment for Perihilar Cholangiocarcinoma: A Single-Center 34-Year Review of 574 Consecutive Resections. Annals of surgery. 2012. Epub 2012/10/13. Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Evolution of Surgical Treatment for Perihilar Cholangiocarcinoma: A Single-Center 34-Year Review of 574 Consecutive Resections. Annals of surgery. 2012. Epub 2012/10/13.
6.
go back to reference Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Annals of surgery. 2003;238(1):73-83. Epub 2003/07/02.PubMedCentralPubMed Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Annals of surgery. 2003;238(1):73-83. Epub 2003/07/02.PubMedCentralPubMed
7.
go back to reference Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Annals of surgery. 1999;230(5):663-71. Epub 1999/11/24.PubMedCentralPubMedCrossRef Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Annals of surgery. 1999;230(5):663-71. Epub 1999/11/24.PubMedCentralPubMedCrossRef
8.
go back to reference Shimada H, Endo I, Fujii Y, Kunihiro O, Tanaka K, Misuta K, et al. Procedure of extended hilar bile duct resection and its application for hilar cholangiocarcinoma. Hepato-gastroenterology. 2002;49(44):300-5. Epub 2002/05/09.PubMed Shimada H, Endo I, Fujii Y, Kunihiro O, Tanaka K, Misuta K, et al. Procedure of extended hilar bile duct resection and its application for hilar cholangiocarcinoma. Hepato-gastroenterology. 2002;49(44):300-5. Epub 2002/05/09.PubMed
9.
go back to reference Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Okaya T, et al. Parenchyma-preserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma. Journal of the American College of Surgeons. 1999;189(6):575-83. Epub 1999/12/10.PubMedCrossRef Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Okaya T, et al. Parenchyma-preserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma. Journal of the American College of Surgeons. 1999;189(6):575-83. Epub 1999/12/10.PubMedCrossRef
10.
go back to reference Shimada H, Endo I, Sugita M, Masunari H, Fujii Y, Tanaka K, et al. Is parenchyma-preserving hepatectomy a noble option in the surgical treatment for high-risk patients with hilar bile duct cancer? Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2003;388(1):33-41. Epub 2003/04/12.PubMed Shimada H, Endo I, Sugita M, Masunari H, Fujii Y, Tanaka K, et al. Is parenchyma-preserving hepatectomy a noble option in the surgical treatment for high-risk patients with hilar bile duct cancer? Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2003;388(1):33-41. Epub 2003/04/12.PubMed
11.
go back to reference Kawarada Y, Das BC, Naganuma T, Tabata M, Taoka H. Surgical treatment of hilar bile duct carcinoma: experience with 25 consecutive hepatectomies. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2002;6(4):617-24. Epub 2002/07/20.CrossRef Kawarada Y, Das BC, Naganuma T, Tabata M, Taoka H. Surgical treatment of hilar bile duct carcinoma: experience with 25 consecutive hepatectomies. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2002;6(4):617-24. Epub 2002/07/20.CrossRef
12.
go back to reference Nakanishi Y, Zen Y, Kawakami H, Kubota K, Itoh T, Hirano S, et al. Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 2008;21(7):807-16. Epub 2008/04/22.CrossRef Nakanishi Y, Zen Y, Kawakami H, Kubota K, Itoh T, Hirano S, et al. Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 2008;21(7):807-16. Epub 2008/04/22.CrossRef
13.
go back to reference 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. Annals of surgery. 2007;246(6):1052-7. Epub 2007/11/29.PubMedCrossRef 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. Annals of surgery. 2007;246(6):1052-7. Epub 2007/11/29.PubMedCrossRef
14.
go back to reference Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. American journal of clinical oncology. 1982;5(6):649-55. Epub 1982/12/01.PubMedCrossRef Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. American journal of clinical oncology. 1982;5(6):649-55. Epub 1982/12/01.PubMedCrossRef
15.
go back to reference Hirano S, Tanaka E, Shichinohe T, Suzuki O, Hazama K, Kitagami H, et al. Treatment strategy for hilar cholangiocarcinoma, with special reference to the limits of ductal resection in right-sided hepatectomies. Journal of hepato-biliary-pancreatic surgery. 2007;14(5):429-33. Epub 2007/10/03.PubMedCrossRef Hirano S, Tanaka E, Shichinohe T, Suzuki O, Hazama K, Kitagami H, et al. Treatment strategy for hilar cholangiocarcinoma, with special reference to the limits of ductal resection in right-sided hepatectomies. Journal of hepato-biliary-pancreatic surgery. 2007;14(5):429-33. Epub 2007/10/03.PubMedCrossRef
16.
go back to reference Masunari H, Shimada H, Endo I, Fujii Y, Tanaka K, Sekido H, et al. Surgical anatomy of hepatic hilum with special reference of the plate system and extrahepatic duct. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2008;12(6):1047-53. Epub 2007/10/17.CrossRef Masunari H, Shimada H, Endo I, Fujii Y, Tanaka K, Sekido H, et al. Surgical anatomy of hepatic hilum with special reference of the plate system and extrahepatic duct. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2008;12(6):1047-53. Epub 2007/10/17.CrossRef
17.
go back to reference Hirano S, Tanaka E, Tsuchikawa T, Matsumoto J, Shichinohe T, Kato K. Techniques of biliary reconstruction following bile duct resection (with video). Journal of hepato-biliary-pancreatic sciences. 2012;19(3):203-9. Epub 2011/11/15.PubMedCentralPubMedCrossRef Hirano S, Tanaka E, Tsuchikawa T, Matsumoto J, Shichinohe T, Kato K. Techniques of biliary reconstruction following bile duct resection (with video). Journal of hepato-biliary-pancreatic sciences. 2012;19(3):203-9. Epub 2011/11/15.PubMedCentralPubMedCrossRef
18.
go back to reference Noji T, Miyamoto M, Kubota KC, Shinohara T, Ambo Y, Matsuno Y, et al. Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer. World journal of surgical oncology. 2012;10:106. Epub 2012/06/12.PubMedCentralPubMedCrossRef Noji T, Miyamoto M, Kubota KC, Shinohara T, Ambo Y, Matsuno Y, et al. Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer. World journal of surgical oncology. 2012;10:106. Epub 2012/06/12.PubMedCentralPubMedCrossRef
19.
go back to reference Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of surgical oncology. 2010;17(6):1471-4. Epub 2010/02/25.PubMedCrossRef Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of surgical oncology. 2010;17(6):1471-4. Epub 2010/02/25.PubMedCrossRef
20.
go back to reference Surgery JSoB. Classification of Biliary Tract Carcinoma Second English Edition. 2nd edition ed: Kanehara Co.,LTD., Tokyo; 2001 2001/04/13. Surgery JSoB. Classification of Biliary Tract Carcinoma Second English Edition. 2nd edition ed: Kanehara Co.,LTD., Tokyo; 2001 2001/04/13.
21.
go back to reference Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K. Safety of combined resection of the middle hepatic artery in right hemihepatectomy for hilar biliary malignancy. Journal of hepato-biliary-pancreatic surgery. 2009;16(6):796-801. Epub 2009/04/24.PubMedCrossRef Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K. Safety of combined resection of the middle hepatic artery in right hemihepatectomy for hilar biliary malignancy. Journal of hepato-biliary-pancreatic surgery. 2009;16(6):796-801. Epub 2009/04/24.PubMedCrossRef
22.
go back to reference Nagino M. Perihilar cholangiocarcinoma: a surgeon’s viewpoint on current topics. Journal of gastroenterology. 2012;47(11):1165-76. Epub 2012/08/01.PubMedCrossRef Nagino M. Perihilar cholangiocarcinoma: a surgeon’s viewpoint on current topics. Journal of gastroenterology. 2012;47(11):1165-76. Epub 2012/08/01.PubMedCrossRef
23.
go back to reference 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. Epub 2007/11/27.PubMedCrossRef 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. Epub 2007/11/27.PubMedCrossRef
24.
go back to reference Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Annals of surgery. 2012;256(2):297-305. Epub 2012/07/04.PubMedCrossRef Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Annals of surgery. 2012;256(2):297-305. Epub 2012/07/04.PubMedCrossRef
25.
go back to reference Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, et al. One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. Journal of hepato-biliary-pancreatic surgery. 2009. Epub 2009/11/26. Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, et al. One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. Journal of hepato-biliary-pancreatic surgery. 2009. Epub 2009/11/26.
26.
go back to reference Aydin U, Yedibela S, Yazici P, Aydinli B, Zeytunlu M, Kilic M, et al. A new technique of biliary reconstruction after "high hilar resection" of hilar cholangiocarcinoma with tumor extension to secondary and tertiary biliary radicals. Annals of surgical oncology. 2008;15(7):1871-9. Epub 2008/05/06.PubMedCrossRef Aydin U, Yedibela S, Yazici P, Aydinli B, Zeytunlu M, Kilic M, et al. A new technique of biliary reconstruction after "high hilar resection" of hilar cholangiocarcinoma with tumor extension to secondary and tertiary biliary radicals. Annals of surgical oncology. 2008;15(7):1871-9. Epub 2008/05/06.PubMedCrossRef
Metadata
Title
Surgical Outcome of Hilar Plate Resection: Extended Hilar Bile Duct Resection Without Hepatectomy
Authors
Takehiro Noji
Takahiro Tsuchikawa
Keisuke Okamura
Toshiaki Shichinohe
Eiichi Tanaka
Satoshi Hirano
Publication date
01-06-2014
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 6/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-014-2490-8

Other articles of this Issue 6/2014

Journal of Gastrointestinal Surgery 6/2014 Go to the issue