Langenbeck's Archives of Surgery

, Volume 388, Issue 3, pp 194–200

Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality

Authors

    • Klinik für Allgemein-Viszeral und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Humboldt University Berlin
  • Sven Jonas
    • Klinik für Allgemein-Viszeral und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Humboldt University Berlin
  • Utz Settmacher
    • Klinik für Allgemein-Viszeral und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Humboldt University Berlin
  • Armin Thelen
    • Klinik für Allgemein-Viszeral und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Humboldt University Berlin
  • Christoph Benckert
    • Klinik für Allgemein-Viszeral und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Humboldt University Berlin
  • Enrique Lopez-Hänninen
    • Strahlenklinik und PoliklinikCharité, Campus Virchow Klinikum, Humboldt University Berlin
  • Rainer E. Hintze
    • Zentrale Interdisziplinäre Endoskopie/Medizinische Klinik mit Schwerpunkt Hepatologie und GastroenterologieCharité, Campus Virchow Klinikum, Humboldt University Berlin
New Surgical Horizons

DOI: 10.1007/s00423-003-0383-5

Cite this article as:
Neuhaus, P., Jonas, S., Settmacher, U. et al. Langenbecks Arch Surg (2003) 388: 194. doi:10.1007/s00423-003-0383-5

Abstract.

Background: Surgical resection provides the only chance of cure for patients suffering from hilar cholangiocarcinoma. Although appropriate procedures are not agreed upon, an increase in radicality has been observed during the past 20 years.

Methods: The literature as well as our own experience after 133 resections of hilar cholangiocarcinomas were reviewed.

Results: Tumor-free margins represent the most important prognostic parameter. Hilar resections as least radical resective procedure will generate rates of formally curative resections of less than 50%. Even after these formally curative resections, long-term survival cannot be achieved. Only additional liver resections will increase the number of long-term survivors to significant figures. In our series, the best 5-year survival rate of 72% was achieved after right trisegmentectomy with concomitant resection of the portal vein bifurcation.

Conclusion: Right trisegmentectomy and combined portal vein resection represent the best way to comply with basic rules of surgical oncology for hilar cholangiocarcinoma. This procedure will provide the most pronounced benefit among various types of liver resection, whereas local resections of the extrahepatic bile duct must be considered as an oncologically inefficient procedure.

Keywords

Bile duct cancerKlatskin tumorCentral bile duct resectionExtended surgery for biliary cancer

Copyright information

© Springer-Verlag 2003