Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection.

OBJECTIVE To evaluate the long-term outcome of aggressive surgery incorporating hepatic resection and systematic nodal dissection for advanced carcinoma involving the hepatic hilus. SUMMARY BACKGROUND DATA Few long-term results are available regarding radical surgery incorporating major hepatectomy and nodal dissection. METHODS A retrospective analysis was undertaken in 107 patients with carcinoma involving the hepatic hilus treated between 1980 and 1997. Resectional surgery was performed in 65 patients, 52 of whom underwent major hepatectomies. The effects of clinical and pathologic factors were assessed by univariate and multivariate analyses. RESULTS Sixty percent of the patients with resectional surgery had stage IVA or IVB disease, and 92.3% of them underwent major hepatectomies. No in-hospital deaths were encountered in the 35 most recent resections, whereas there were six deaths in the early period. Resectional surgery was associated with a survival benefit, especially when resection margins were free from cancerous infiltration. The estimated 5-year survival rate after resection, including all deaths, was 34.8%; this was 51.6% when the margins were clear. Nodal involvement was documented in 44.6% of the resections. However, patients with metastases limited to the regional nodes showed a survival rate similar to that in patients without nodal involvement. Significant predictive factors for survival after resection were extension to the gallbladder, nodal status, resectional margins, histologic type, and gender. CONCLUSIONS The combination of major hepatectomy with systematic nodal dissection gave a good chance of prolonged survival for patients with carcinoma involving the hepatic hilus, even when the disease was advanced. Less-extensive procedures were also beneficial for less-advanced disease if clear resectional margins were secured.

[1]  W. Jarnagin,et al.  Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. , 1998, Annals of surgery.

[2]  B. Greenway,et al.  Effect of flutamide on survival in patients with pancreatic cancer: results of a prospective, randomised, double blind, placebo controlled trial , 1998, BMJ.

[3]  W. Jarnagin,et al.  Intrahepatic biliary enteric bypass provides effective palliation in selected patients with malignant obstruction at the hepatic duct confluence. , 1998, American journal of surgery.

[4]  S. Fan,et al.  Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumors. , 1998, Archives of surgery.

[5]  M. Nagino,et al.  The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. , 1998, Annals of surgery.

[6]  M. Miyazaki,et al.  Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? , 1998, Surgery.

[7]  Randall G. Lee,et al.  Liver resection for hilar and peripheral cholangiocarcinomas: a study of 62 cases. , 1998, Annals of surgery.

[8]  M. Nagino,et al.  Segmental liver resections for hilar cholangiocarcinoma. , 1998, Hepato-gastroenterology.

[9]  R. Wasielewski,et al.  Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  R. Prokesch,et al.  Biliary Wallstent endoprosthesis in malignant hilar obstruction: long-term results with regard to the type of obstruction. , 1997, Clinical radiology.

[11]  T. Bowling,et al.  A retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma. , 1996, Gut.

[12]  C. Su,et al.  Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. , 1996, Annals of surgery.

[13]  K. Schupak,et al.  Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy , 1995, The British journal of surgery.

[14]  S. Kawasaki,et al.  Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer. , 1995, Archives of surgery.

[15]  K. Lillemoe,et al.  Perihilar Cholangiocarcinoma Postoperative Radiotherapy Does Not Improve Survival , 1995, Annals of surgery.

[16]  R. Jenkins,et al.  Aggressive surgical resection for cholangiocarcinoma. , 1995, Archives of surgery.

[17]  M. Wannenmacher,et al.  Combined external beam radiotherapy and intraluminal high dose rate brachytherapy on bile duct carcinomas. , 1994, International journal of radiation oncology, biology, physics.

[18]  S. Kawasaki,et al.  Radical operation after portal embolization for tumor of hilar bile duct. , 1994, Journal of the American College of Surgeons.

[19]  L. Way,et al.  Carcinoma of the Extrahepatic Bile Ducts The University of California at San Francisco Experience , 1994, Annals of surgery.

[20]  A. Sugioka,et al.  Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: a cooperative study of the Keio Bile Duct Cancer Study Group. , 1994, Surgery.

[21]  G. Haddock,et al.  Changing trends in the management of extrahepatic cholangiocarcinoma , 1993, The British journal of surgery.

[22]  J. Donohue,et al.  Outcomes after curative resections of cholangiocarcinoma. , 1993, Archives of surgery.

[23]  M. Makuuchi,et al.  Long-term results after resection of hepatocellular carcinoma: experience of 480 cases. , 1993, Hepato-gastroenterology.

[24]  T. Todoroki,et al.  Long-term survivors after salvage surgery combined with radiotherapy for recurrence of stage IV main hepatic duct cancer--report of two cases. , 1993, Hepato-gastroenterology.

[25]  M. J. Hart,et al.  Aggressive surgical therapy for Klatskin tumors. , 1993, American journal of surgery.

[26]  S. Tashiro,et al.  Prolongation of survival for carcinoma at the hepatic duct confluence. , 1993, Surgery.

[27]  L. Blumgart,et al.  Improvements in Survival by Aggressive Resections of Hilar Cholangiocarcinoma , 1993, Annals of surgery.

[28]  H. Bismuth,et al.  Management strategies in resection for hilar cholangiocarcinoma. , 1992, Annals of surgery.

[29]  R. Reding,et al.  Surgical management of 552 carcinomas of the extrahepatic bile ducts (gallbladder and periampullary tumors excluded). Results of the French Surgical Association Survey. , 1991, Annals of surgery.

[30]  L. Blumgart,et al.  Outcome of radical surgery in hilar cholangiocarcinoma. , 1990, Surgery.

[31]  M. Makuuchi,et al.  Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. , 1990, Surgery.

[32]  L. Holmberg,et al.  The effect of female sex hormones on cancer survival. A register-based study in patients younger than 20 years at diagnosis. , 1990, JAMA.

[33]  S. Kuramochi,et al.  Carcinoma of the main hepatic duct junction: indications, operative morbidity and mortality, and long-term survival. , 1990, Surgery.

[34]  J. Cameron,et al.  Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. , 1990, American journal of surgery.

[35]  K. Tranberg,et al.  Major Liver Resection for Hilar Cholangiocarcinoma , 1988, Annals of surgery.

[36]  B. Greenway.  Carcinoma of the exocrine pancreas: A sex hormone responsive tumour? , 1987, The British journal of surgery.

[37]  L. Blumgart,et al.  SURGICAL APPROACHES TO CHOLANGIOCARCINOMA AT CONFLUENCE OF HEPATIC DUCTS , 1984, The Lancet.

[38]  Y. Ogata,et al.  Carcinoma of the bifurcation of the hepatic ducts. , 1983, Archives of surgery.

[39]  M. Makuuchi,et al.  Ultrasonically guided percutaneous transhepatic bile drainage: a single-step procedure without cholangiography. , 1980, Radiology.

[40]  P. Brissot,et al.  Carcinoma of the Hepatic Hilus Surgical Management and the Case for Resection , 1979, Annals of surgery.

[41]  R. Praderi.  Twelve Years' Experience with Transhepatic lntubation , 1974, Annals of surgery.

[42]  J. Louw,et al.  Prolonged palliation in carcinoma of the man hepatic duct junction. , 1972, Surgery.

[43]  R. Sullivan,et al.  Hepaticojejunostomy. Modified longmire operation for bile duct carcinoma. , 1967, American journal of surgery.

[44]  G. Klatskin.  CONGENITAL HEMOLYTIC JAUNDICE CORRECTED BY SPLENECTOMY FOLLOWED TWENTY-SIX YEARS LATER BY BLEEDING TENDENCY, HEPATOMEGALY AND SUDDEN DEATH. , 1965, The American journal of medicine.

[45]  G. Klatskin.  ADENOCARCINOMA OF THE HEPATIC DUCT AT ITS BIFURCATION WITHIN THE PORTA HEPATIS. AN UNUSUAL TUMOR WITH DISTINCTIVE CLINICAL AND PATHOLOGICAL FEATURES. , 1965, The American journal of medicine.