Aggressive surgical resection for hilar cholangiocarcinoma: is it justified? Audit of a single center's experience

Abstract Background The current study presents our experience with resectional surgery for patients with hilar cholangiocarcinoma (HC). Methods Medical records of 73 HC patients who were referred to our department between 1988 and 2006 were reviewed. Resectability rate, surgical mortality, and facto...

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Published in:The American journal of surgery 2008-08, Vol.196 (2), p.160-169
Main Authors: Konstadoulakis, Manousos M., M.D., Ph.D, Roayaie, Sasan, M.D, Gomatos, Ilias P., M.D, Labow, Daniel, M.D, Fiel, Maria-Isabell, M.D, Miller, Charles M., M.D, Schwartz, Myron E., M.D
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Bile
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - pathology
Bile Duct Neoplasms - surgery
Bile Ducts, Intrahepatic - surgery
Biological and medical sciences
Cholangiocarcinoma - mortality
Cholangiocarcinoma - pathology
Cholangiocarcinoma - surgery
Cholecystectomy
Confidence intervals
Female
Follow-Up Studies
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Hepatectomy
Hilar cholangiocarcinoma
Hospital Mortality
Humans
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical Audit
Medical sciences
Middle Aged
Morbidity
Mortality
Multivariate analysis
Patients
Portal Vein - surgery
Prognosis
Surgery
Survival Analysis
Tumors
Veins & arteries
Vena Cava, Inferior - surgery
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Summary:Abstract Background The current study presents our experience with resectional surgery for patients with hilar cholangiocarcinoma (HC). Methods Medical records of 73 HC patients who were referred to our department between 1988 and 2006 were reviewed. Resectability rate, surgical mortality, and factors contributing to survival were investigated. Results Resectional surgery was performed in 59 patients (80.8%), 51 of whom (86.4%) underwent major hepatic resection. Negative margins were obtained in 35 of 51 patients (68.6%) and were associated with right-sided hepatectomy (80% vs 20%, P = .049). In-hospital mortality and morbidity were 6.8% and 25.4%, respectively. One-, 3- and 5-year survival rates after liver resection were 86%, 48.9%, and 34.9%, respectively. Histologic differentiation, left-sided hepatectomy, and inferior vena cava resection independently predicted survival. Patients undergoing R1 hepatectomy had significantly improved 5-year survival rates compared with patients who were unresectable ( P
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2007.07.033