Journal of Gastrointestinal Surgery

, Volume 17, Issue 7, pp 1247–1256

A Simple System to Predict Perihilar Cholangiocarcinoma Resectability

Authors

    • Service de Chirurgie Hépatobiliaire et DigestiveCentre Hospitalier Universitaire de Rennes, Université de Rennes 1
  • Laurent Sulpice
    • Service de Chirurgie Hépatobiliaire et DigestiveCentre Hospitalier Universitaire de Rennes, Université de Rennes 1
  • Sylvain Garnier
    • Service de Chirurgie Hépatobiliaire et DigestiveCentre Hospitalier Universitaire de Rennes, Université de Rennes 1
  • Jean-François Bretagne
    • Service des Maladies de l’Appareil DigestifCentre Hospitalier Universitaire de Rennes, Université de Rennes 1
  • Yves Gandon
    • Service d’Imagerie Abdominale et GénéraleCentre Hospitalier Universitaire de Rennes, Université de Rennes 1
  • Tanguy Rohou
    • Service d’Imagerie Abdominale et GénéraleCentre Hospitalier Universitaire de Rennes, Université de Rennes 1
Original Article

DOI: 10.1007/s11605-013-2215-4

Cite this article as:
Boudjema, K., Sulpice, L., Garnier, S. et al. J Gastrointest Surg (2013) 17: 1247. doi:10.1007/s11605-013-2215-4

Abstract

Background

The aim of this study was to retrospectively validate a new system to predict perihilar cholangiocarcinoma (PHC) resectability. We hypothesized that when the left lateral section (segments II–III) duct confluence (LLC) is free, the left lateral section might be preserved for curative resection. When the LLC is invaded, vascular invasion is frequent and radical resection might often be impossible without complex vascular reconstruction.

Method

Radiological files of patients operated for PHC at our institution were reviewed and PHC was classified depending on whether LLC was invaded (type X) or free (type Y). Peroperative findings and follow-up were then matched with our XY classification.

Results

Thirty-seven patients were included, 28 (78 %) type Y and nine (22 %) type X PHCs. Hepatic artery (HA) invasion was present in 14 % of type Y and 100 % of type X PHCs (P < 0.001). Left HA was never involved in type Y and always involved in type X. Portal vein invasion was present in 25 and 78 % of type Y and type X PHC, respectively (P = 0.014). Complete resection rates without HA in type Y and X patients were 89 % (84 % R0 and 16 % R1) and 33 % (37.5 % R0 and 12.5 % R1), respectively (P = 0.01). Sensitivity, specificity, and precision of the XY classification to predict resectability were 84, 67, and 84 %, respectively.

Conclusion

XY classification for PHCs suggests that in type Y (free LLC), the tumor is most often resectable, while in type X (LLC involved), the tumor is only resectable using complex vascular reconstructions.

Keywords

Perihilar cholangiocarcinomaHilar cancerKlatskin tumourSurgeryHilar cholangiocarcinoma

Abbreviations

BC

Bismuth–Corlette

RRC

Right anterior and right posterior duct confluence

RLC

Right and left hepatic duct confluence

LLC

Segments II and III (left lateral section) duct confluence

LHD

Left hepatic duct

CHD

Common hepatic duct

MRI

Magnetic resonance imaging

MRC

Magnetic resonance cholangiography

MDCT

Multidetector computed tomography

Copyright information

© The Society for Surgery of the Alimentary Tract 2013