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A Simple System to Predict Perihilar Cholangiocarcinoma Resectability

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Journal of Gastrointestinal Surgery Aims and scope

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.

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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

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Acknowledgments

The authors thank Peter Tucker for his help in reviewing the manuscript.

Conflict of Interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France

    Karim Boudjema, Laurent Sulpice & Sylvain Garnier

  2. Service des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France

    Jean-François Bretagne

  3. Service d’Imagerie Abdominale et Générale, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France

    Yves Gandon & Tanguy Rohou

Authors
  1. Karim Boudjema
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  2. Laurent Sulpice
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  3. Sylvain Garnier
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  4. Jean-François Bretagne
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  5. Yves Gandon
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  6. Tanguy Rohou
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Correspondence to Karim Boudjema.

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Boudjema, K., Sulpice, L., Garnier, S. et al. A Simple System to Predict Perihilar Cholangiocarcinoma Resectability. J Gastrointest Surg 17, 1247–1256 (2013). https://doi.org/10.1007/s11605-013-2215-4

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  • DOI: https://doi.org/10.1007/s11605-013-2215-4

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