Resection and Drainage of Hilar Cholangiocarcinoma: An 11-Year Experience of a Single Center in Mainland China

• Published in: The American surgeon 2011-05, Vol.77 (5), p.627-633
• Main Authors: ZHENG-RONG, Lian, HAI-BO, You, CHEN XIN, WU, Chuan-Xin, LIU, Zuo-Jin, TU BING, GONG, Jian-Ping, LI, Sheng-Wei
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic; Biological and medical sciences; Biopsy, Needle; China; Cholangiocarcinoma - mortality; Cholangiocarcinoma - pathology; Cholangiocarcinoma - surgery; Cohort Studies; Combined Modality Therapy; Diabetes; Diagnostic Imaging - methods; Disease-Free Survival; Drainage - methods; Drainage - mortality; Female; Gallbladder diseases; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hepatectomy - methods; Hepatectomy - mortality; Hospitals, University; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Liver; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Mortality; Neoplasm Invasiveness - pathology; Neoplasm Staging; Pain; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Prognosis; Retrospective Studies; Risk Assessment; Standard deviation; Statistics, Nonparametric; Survival Analysis; Time Factors; Tumors; Weight control
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481107700525

The purpose of this study is to provide appropriate approaches for resection and drainage of hilar cholangiocarcinomas. Surgical approaches and postoperative survival rates of the patients were analyzed retrospectively. The 1-, 3-, and 5-year cumulative survival rates for patients who underwent resection were 76.6, 36.2, and 10.6 per cent, which was higher than those of 60, 14.3, and 0 per cent, respectively, in palliative operation. Moreover, the 1-, 3-, and 5-year cumulative survival rates for patients who underwent R0 were 88.9, 44.4, and 13.9 per cent, which was improved compared with those of 36.4, 9.1, and 0 per cent, respectively, in nonR0 resection. In addition, the overall survival time of patients who underwent R0 resection combined with hemihepatectomy and caudate lobe resection was longer than of those who underwent R0 without this extra operation, especially within 3 years after operation. After endoscopic metal biliary endoprothesis for patients who were intolerant of resection, liver function was improved at 2 weeks postoperation and the 1-, 3-, and 5-year cumulative survival rates for these patients were 72.7, 18.2, and 0 per cent, respectively. Treatment should be personalized. Resection is the most efficacious therapy, and negative histologic margins should be achieved in radical operation and "skeletonized" surgical operation is the basic requirement of radical treatment of hilar cholangiocarcinoma. Portal vein resection is beneficial to long-term survival and R0 resection combined with caudate lobe resection and hemihepatectomy is more efficacious for patients with Bismuth-Corlette type III hilar cholangiocarcinoma. The preferred approach of drainage in palliative operation is endoscopic metal biliary endoprothesis, which is more appropriate than tumor resection for the patients who suffer from serious comorbidities.