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Published in: World Journal of Surgery 6/2007

01-06-2007

Surgical Resection of Hilar Cholangiocarcinoma: Analysis of Survival and Postoperative Complications

Authors: Suguru Hasegawa, Iwao Ikai, Hideaki Fujii, Etsuro Hatano, Yasuyuki Shimahara

Published in: World Journal of Surgery | Issue 6/2007

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Abstract

Background

Surgery is the only potentially curative treatment for hilar bile duct cancer. This study sought to evaluate the efficacy and feasibility of surgical management of hilar bile duct carcinoma, including radical hepatectomy, at a single institution.

Methods

We performed a retrospective review of 49 consecutive patients who underwent surgery at our hospital between 1990 and 2003.

Results

Altogether, 44 of 49 patients underwent radical hepatectomy combined with caudate lobectomy and lymphadenectomy. One and four patients underwent partial hepatectomy or bile duct resection, respectively. No patients underwent preoperative portal vein embolization. The 5-year survival rate was 39.7%, with a median survival time of 3.75 years. The postoperative morbidity and mortality rates were 46.8% and 2.0%, respectively. Cox’s proportional hazard model revealed that lymph node status and the residual tumor factor were independent prognostic factors. Multivariate analysis revealed that preoperative hyperbilirubinemia, postoperative complications, and extended surgical procedures were independently associated with postoperative hyperbilirubinemia. After potentially curative resection, 39.4% of patients suffered from disease recurrence. In 60% of the total cases, the sites of recurrence were distant metastases.

Conclusion

Surgery, including radical hepatectomy combined with caudate lobectomy and lymph node dissection, is a feasible, effective treatment for hilar bile duct cancer.
Literature
1.
go back to reference Altemeier WA, Gall EA, Zinninger MM, et al. (1957) Sclerosing carcinoma of the major intrahepatic bile ducts. AMA Arch Surg 75:450–460PubMed Altemeier WA, Gall EA, Zinninger MM, et al. (1957) Sclerosing carcinoma of the major intrahepatic bile ducts. AMA Arch Surg 75:450–460PubMed
2.
go back to reference Klatskin G (1965) Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis: an unusual tumor with distinctive clinical and pathological features. Am J Med 38:241–256PubMedCrossRef Klatskin G (1965) Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis: an unusual tumor with distinctive clinical and pathological features. Am J Med 38:241–256PubMedCrossRef
3.
go back to reference Kuwayti K, Baggenstoss AH, Stauffer MH, et al. (1957) Carcinoma of the major intrahepatic and the extrahepatic bile ducts exclusive of the papilla of Vater. Surg Gynecol Obstet 104:357–366PubMed Kuwayti K, Baggenstoss AH, Stauffer MH, et al. (1957) Carcinoma of the major intrahepatic and the extrahepatic bile ducts exclusive of the papilla of Vater. Surg Gynecol Obstet 104:357–366PubMed
4.
go back to reference Kawarada Y, Higashiguchi T, Yokoi H, et al. (1995) Preoperative biliary drainage in obstructive jaundice. Hepatogastroenterology 42:300–307PubMed Kawarada Y, Higashiguchi T, Yokoi H, et al. (1995) Preoperative biliary drainage in obstructive jaundice. Hepatogastroenterology 42:300–307PubMed
5.
go back to reference Mizuta A, Chijiiwa K, Saiki S, et al. (2002) Differences in biliary lipid excretion after major hepatectomy in obstructive jaundiced rats with preoperative internal, external, or no biliary drainage. Eur Surg Res 34:291–299PubMedCrossRef Mizuta A, Chijiiwa K, Saiki S, et al. (2002) Differences in biliary lipid excretion after major hepatectomy in obstructive jaundiced rats with preoperative internal, external, or no biliary drainage. Eur Surg Res 34:291–299PubMedCrossRef
6.
go back to reference Nimura Y, Kaimya J, Kondo S, et al. (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7:155–162PubMedCrossRef Nimura Y, Kaimya J, Kondo S, et al. (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7:155–162PubMedCrossRef
7.
go back to reference Hemming AW, Reed AI, Howard RJ, et al. (2003) Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237:686–693PubMedCrossRef Hemming AW, Reed AI, Howard RJ, et al. (2003) Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237:686–693PubMedCrossRef
8.
go back to reference Abdalla EK, Barnett CC, Doherty D, et al. (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137:675–681PubMedCrossRef Abdalla EK, Barnett CC, Doherty D, et al. (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137:675–681PubMedCrossRef
9.
go back to reference Imamura H, Shimada R, Kubota M, et al. (1999) Preoperative portal vein embolization: an audit of 84 patients. Hepatology 29:1099–1105PubMedCrossRef Imamura H, Shimada R, Kubota M, et al. (1999) Preoperative portal vein embolization: an audit of 84 patients. Hepatology 29:1099–1105PubMedCrossRef
10.
go back to reference Bismuth H, Nakache R, Diamond T (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215:31–38PubMedCrossRef Bismuth H, Nakache R, Diamond T (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215:31–38PubMedCrossRef
11.
go back to reference Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–5PubMedCrossRef Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–5PubMedCrossRef
12.
go back to reference UICC (2002) International Union Against Cancer (UICC) TNM Classification of Malignant Tumors. 6th edition. New York: Wiley-Liss UICC (2002) International Union Against Cancer (UICC) TNM Classification of Malignant Tumors. 6th edition. New York: Wiley-Liss
13.
go back to reference Iwatsuki S, Todo S, Marsh JW, et al. (1998) Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg 187:358–364PubMedCrossRef Iwatsuki S, Todo S, Marsh JW, et al. (1998) Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg 187:358–364PubMedCrossRef
14.
go back to reference Kosuge T, Yamamoto J, Shimada K, et al. (1999) Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg 230:663–671PubMedCrossRef Kosuge T, Yamamoto J, Shimada K, et al. (1999) Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg 230:663–671PubMedCrossRef
15.
go back to reference Neuhaus P, Jonas S, Bechstein WO, et al. (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–818PubMedCrossRef Neuhaus P, Jonas S, Bechstein WO, et al. (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–818PubMedCrossRef
16.
go back to reference Gazzaniga GM, Filauro M, Bagarolo C, et al. (2000) Surgery for hilar cholangiocarcinoma: an Italian experience. J Hepatobiliary Pancreat Surg 7:122–127PubMedCrossRef Gazzaniga GM, Filauro M, Bagarolo C, et al. (2000) Surgery for hilar cholangiocarcinoma: an Italian experience. J Hepatobiliary Pancreat Surg 7:122–127PubMedCrossRef
17.
go back to reference Lillemoe KD, Cameron JL (2000) Surgery for hilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobiliary Pancreat Surg 7:115–121PubMedCrossRef Lillemoe KD, Cameron JL (2000) Surgery for hilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobiliary Pancreat Surg 7:115–121PubMedCrossRef
18.
go back to reference Jarnagin WR, Fong Y, DeMatteo RP, et al. (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517PubMedCrossRef Jarnagin WR, Fong Y, DeMatteo RP, et al. (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517PubMedCrossRef
19.
go back to reference Kawarada Y, Das BC, Naganuma T, et al. (2002) Surgical treatment of hilar bile duct carcinoma: experience with 25 consecutive hepatectomies. J Gastrointest Surg 6:617–624PubMedCrossRef Kawarada Y, Das BC, Naganuma T, et al. (2002) Surgical treatment of hilar bile duct carcinoma: experience with 25 consecutive hepatectomies. J Gastrointest Surg 6:617–624PubMedCrossRef
20.
go back to reference Kawasaki S, Imamura H, Kobayashi A, et al. (2003) 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 238:84–92PubMedCrossRef Kawasaki S, Imamura H, Kobayashi A, et al. (2003) 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 238:84–92PubMedCrossRef
21.
go back to reference Seyama Y, Kubota K, Sano K, et al. (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83PubMedCrossRef Seyama Y, Kubota K, Sano K, et al. (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83PubMedCrossRef
22.
go back to reference Kondo S, Hirano S, Ambo Y, et al. (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101PubMedCrossRef Kondo S, Hirano S, Ambo Y, et al. (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101PubMedCrossRef
23.
go back to reference Rea DJ, Munoz-Juarez M, Farnell MB, et al. (2004) Major hepatic resection for hilar cholangiocarcinoma: analysis of 46 patients. Arch Surg 139:514–523PubMedCrossRef Rea DJ, Munoz-Juarez M, Farnell MB, et al. (2004) Major hepatic resection for hilar cholangiocarcinoma: analysis of 46 patients. Arch Surg 139:514–523PubMedCrossRef
24.
go back to reference Klempnauer J, Ridder GJ, von Wasielewski R, et al. (1997) Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 15:947–954PubMed Klempnauer J, Ridder GJ, von Wasielewski R, et al. (1997) Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 15:947–954PubMed
25.
go back to reference Kitagawa Y, Nagino M, Kamiya J, et al. (2001) Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 233:385–392PubMedCrossRef Kitagawa Y, Nagino M, Kamiya J, et al. (2001) Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 233:385–392PubMedCrossRef
26.
go back to reference Hatfield ARW, Terblanche J, Fataar S, et al. (1982) Preoperative external biliary drainage in obstructive jaundice: a prospective controlled clinical trial. Lancet 23:896–899CrossRef Hatfield ARW, Terblanche J, Fataar S, et al. (1982) Preoperative external biliary drainage in obstructive jaundice: a prospective controlled clinical trial. Lancet 23:896–899CrossRef
27.
go back to reference McPherson GAD, Benjamin IS, Hodgson HJF, et al. (1984) Preoperative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg 71:371–375PubMedCrossRef McPherson GAD, Benjamin IS, Hodgson HJF, et al. (1984) Preoperative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg 71:371–375PubMedCrossRef
28.
go back to reference Pitt HA, Gomes AS, Lois JF, et al. (1985) Does preoperative biliary drainage reduce operative risk or increase hospital cost? Ann Surg 201:545–553PubMedCrossRef Pitt HA, Gomes AS, Lois JF, et al. (1985) Does preoperative biliary drainage reduce operative risk or increase hospital cost? Ann Surg 201:545–553PubMedCrossRef
29.
go back to reference Cherqui DC, Bonoist S, Malassagne B, et al. (2000) Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg 135:302–308PubMedCrossRef Cherqui DC, Bonoist S, Malassagne B, et al. (2000) Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg 135:302–308PubMedCrossRef
30.
go back to reference Mizumoto R, Kawarada Y, Yamawaki T, et al. (1979) Resectability and functional reserve of the liver with obstructive jaundice in dogs. Am J Surg 137:768–772PubMedCrossRef Mizumoto R, Kawarada Y, Yamawaki T, et al. (1979) Resectability and functional reserve of the liver with obstructive jaundice in dogs. Am J Surg 137:768–772PubMedCrossRef
31.
go back to reference Schindl MJ, Redhead DN, Fearon KCH, et al. (2005) The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54:289–296PubMedCrossRef Schindl MJ, Redhead DN, Fearon KCH, et al. (2005) The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54:289–296PubMedCrossRef
32.
go back to reference Farges O, Belghiti J, Kianmanesh R, et al. (2003) Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 237:208–217PubMedCrossRef Farges O, Belghiti J, Kianmanesh R, et al. (2003) Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 237:208–217PubMedCrossRef
33.
go back to reference Abdalla EK, Hicks ME, Vauthey JN (2001) Portal vein embolization: rationale, technique and future prospects. Br J Surg 88:165–175PubMedCrossRef Abdalla EK, Hicks ME, Vauthey JN (2001) Portal vein embolization: rationale, technique and future prospects. Br J Surg 88:165–175PubMedCrossRef
34.
go back to reference Kokudo N, Tada K, Seki M, et al. (2001) Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 34:267–272PubMedCrossRef Kokudo N, Tada K, Seki M, et al. (2001) Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 34:267–272PubMedCrossRef
35.
go back to reference Wakabayashi H, Ishimura K, Okano K, et al. (2001) Is preoperative portal vein embolization effective in improving prognosis after major hepatic resection in patients with advanced-stage hepatocellular carcinoma? Cancer 92:2384–2390PubMedCrossRef Wakabayashi H, Ishimura K, Okano K, et al. (2001) Is preoperative portal vein embolization effective in improving prognosis after major hepatic resection in patients with advanced-stage hepatocellular carcinoma? Cancer 92:2384–2390PubMedCrossRef
36.
go back to reference Jarnagin WR, Ruo L, Little SA, et al. (2003) Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer 98:1689–1700PubMedCrossRef Jarnagin WR, Ruo L, Little SA, et al. (2003) Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer 98:1689–1700PubMedCrossRef
37.
38.
go back to reference Lin MH, Chen JS, Chen HH, et al. (2003) A phase II trial of gemcitabine in the treatment of advanced bile duct and periampullary carcinomas. Chemotherapy 49:154–158PubMedCrossRef Lin MH, Chen JS, Chen HH, et al. (2003) A phase II trial of gemcitabine in the treatment of advanced bile duct and periampullary carcinomas. Chemotherapy 49:154–158PubMedCrossRef
39.
go back to reference Kubicka S, Rudolph KL, Tietze MK, et al. (2001) Phase II study of systemic gemcitabine chemotherapy for advanced unresectable hepatobiliary carcinomas. Hepatogastroenterology 48:783–789PubMed Kubicka S, Rudolph KL, Tietze MK, et al. (2001) Phase II study of systemic gemcitabine chemotherapy for advanced unresectable hepatobiliary carcinomas. Hepatogastroenterology 48:783–789PubMed
Metadata
Title
Surgical Resection of Hilar Cholangiocarcinoma: Analysis of Survival and Postoperative Complications
Authors
Suguru Hasegawa
Iwao Ikai
Hideaki Fujii
Etsuro Hatano
Yasuyuki Shimahara
Publication date
01-06-2007
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 6/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-007-9001-y

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