Article

World Journal of Surgery

, Volume 37, Issue 3, pp 614-621

First online:

One-stage Resection for Bismuth Type IV Hilar Cholangiocarcinoma with High Hilar Resection and Parenchyma-preserving Strategies: A Cohort Study

  • Jing Wang TanAffiliated withPLA General Hospital, Institute of Hepatobiliary Surgery Email author 
  • , Ben Shun HuAffiliated withPLA General Hospital, Institute of Hepatobiliary Surgery
  • , Ya Juan ChuAffiliated withHepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University
  • , Yun Chang TanAffiliated withHepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University
  • , Xu JiAffiliated withPLA General Hospital, Institute of Hepatobiliary Surgery
  • , Ke ChenAffiliated withHepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University
  • , Xiang Min DingAffiliated withHepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University
  • , Aiqun ZhangAffiliated withPLA General Hospital, Institute of Hepatobiliary Surgery
  • , Fei ChenAffiliated withPLA General Hospital, Institute of Hepatobiliary Surgery
    • , Jia Hong DongAffiliated withPLA General Hospital, Institute of Hepatobiliary Surgery

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Abstract

Background

Bismuth type IV hilar cholangiocarcinoma (HC) tumors are usually considered unresectable. The strategies of high hilar resection while preserving liver parenchyma can achieve potentially one-stage curative resection for this condition. The aim of the present study was to investigate the feasibility and safety of available strategies.

Methods

Fifty-one consecutive patients with bismuth type IV HC who underwent one-stage resection were retrospectively reviewed with regard to curative resection rate, remnant liver volume, morbidity, mortality, and survival time.

Results

The total median survival time was 29 months. The R0 (curative resection) rate was 57.8 %. The ratio of the remnant liver volume (RLV) to the standard liver volume (SLV) ranged from 35.0 to 60.6 %, with a mean of 44.5 %. The in-hospital mortality and morbidity rates were 3.9 and 37.2 %, respectively. In the R0 patients’ survival, there was not a significant difference between bilioenteric anastomosis and hepatoenteric anastomosis (P = 0.714).

Conclusions

Combined caudate lobe and high hilar resection (CCHR) is technically safe and oncologically justifiable and could be adopted with a high cure rate as a one-stage resection procedure for most patients with Bismuth type IV HC whose total bilirubin level is less than 20 mg/L and whose direct bilirubin is more than 60 % of total bilirubin.