Journal of Gastrointestinal Surgery

, Volume 15, Issue 3, pp 480–488

Surgery for Hilar Cholangiocarcinoma: A Multi-institutional Update on Practice and Outcome by the AFC-HC Study Group

  • Jean Marc Regimbeau
  • David Fuks
  • Yves-Patrice Le Treut
  • Philippe Bachellier
  • Jacques Belghiti
  • Karim Boudjema
  • Jacques Baulieux
  • François-René Pruvot
  • Daniel Cherqui
  • Olivier Farges
Original Article

DOI: 10.1007/s11605-011-1414-0

Cite this article as:
Regimbeau, J.M., Fuks, D., Le Treut, Y. et al. J Gastrointest Surg (2011) 15: 480. doi:10.1007/s11605-011-1414-0

Abstract

Introduction

Surgical resection is the only option for long-term survival in patients with hilar cholangiocarcinoma (HC), but it is associated with high morbidity and mortality. The aim of the present study was to prospectively assess the perioperative management and short-term outcomes of surgical treatment of HC in a recent, multi-institutional study with a short inclusion period.

Methods

Between January and December 2008, a register prospectively collected data on patients operated on for HC (exploratory or curative surgery) in eight tertiary centers. The register focused on perioperative management, resectability, surgical procedures employed, morbidity, and mortality. The study cohort consisted of 56 patients (40 men and 16 women) with a median age of 63 years (range, 33–83 years).

Results

Among the 56 patients, 47 (84%) were jaundiced and 42 (75%) tumors were classified as Bismuth–Corlette type III–IV. Nine patients (16%) underwent staging laparoscopy and four (7%) received neoadjuvant chemotherapy. Preoperative biliary drainage (endoscopy, 42%) was performed in 38 (81%) jaundiced patients and portal vein embolization (right side, 83%) was performed prior to surgery in 18 patients (32%). Among these 56 patients, curative resection was achieved in 39 (70%). All underwent major liver resection (>3 segments), bile duct resection, and lymphadenectomy. Thirteen patients (36%) underwent portal vein resection, one of whom also required pancreaticoduodenectomy. Eighty-two percent of resected patients (n = 32) had no proof of malignancy prior to hepatectomy. Clear surgical margins were obtained in 77% (n = 30). The postoperative mortality was 8% and complications occurred in 72% of the resected patients. Seven (25%) patients required reoperation, and 15 (54%) patients required percutaneous drainage. In a univariate analysis, the risk factors for morbidity were intraoperative blood transfusion (p = 0.009) and vascular clamping (p = 0.006). The median length of hospitalization was 20 ± 13 days.

Conclusion

Curative resection for HC is associated with a high rate of R0 resection. However, surgery is associated with high levels of morbidity and mortality, despite intensive perioperative management.

Keywords

Hilar cholangiocarcinomaPreoperative managementMorbidityMortality

Abbreviations

HC

Hilar cholangiocarcinoma

PVE

Portal vein embolization

SD

Standard deviation

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Jean Marc Regimbeau
    • 1
  • David Fuks
    • 1
  • Yves-Patrice Le Treut
    • 2
  • Philippe Bachellier
    • 3
  • Jacques Belghiti
    • 4
  • Karim Boudjema
    • 5
  • Jacques Baulieux
    • 6
  • François-René Pruvot
    • 7
  • Daniel Cherqui
    • 8
  • Olivier Farges
    • 4
  1. 1.Department of Digestive Surgery, Hôpital NordUniversity of Picardy Medical CenterAmiens Cedex 01France
  2. 2.Department of Hepatobiliary SurgeryHôpital Conception, Assistance-Publique Hôpitaux de MarseilleMarseilleFrance
  3. 3.Department of Hepatobiliary SurgeryHôpital HautepierreStrasbourgFrance
  4. 4.Department of Hepatobiliary SurgeryHôpital Beaujon, Assistance-Publique Hôpitaux de ParisClichyFrance
  5. 5.Department of Hepatobiliary SurgeryHôpital PontchaillouRennesFrance
  6. 6.Department of Hepatobiliary SurgeryHôpital Croix RousseLyonFrance
  7. 7.Department of Hepatobiliary SurgeryHôpital Claude HuriezLilleFrance
  8. 8.Department of Hepatobiliary SurgeryHôpital Mondor, Assistance-Publique Hôpitaux de ParisCréteilFrance