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.
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References
Okuda K, Kubo Y, Okazaki N, Arishima T, Hashimoto M (1977) Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma: a study of 57 autopsy-proven cases. Cancer 39:232–246
Bhuiya M-R, Nimura Y, Kamiya J, Kondo S, Fukata S, Hayakawa N, Shionoya S (1992) Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg 215:344–349
Weinbren K, Mutum S-S (1983) Pathological aspects of cholangiocarcinoma. J Pathol 139:217–238
Born P, Rosch T, Willkomm G, Sandschin W, Fitz N, Weigert N, Ott R, Frimberger E, Allescher H, Classen M (1999) Initial experience with a new Yamakawa-type prosthesis for long-term percutaneous transhepatic drainage. Endoscopy 31:748–750
Kaufman S-L (1995) Percutaneous palliation of unresectable pancreatic cancer. Surg Clin North Am 75:989–999
Schlitt H-J, Weimann A, Klempnauer J, Oldhafer K-J, Nashan B, Raab R, Pichlmayr R (1999) Peripheral hepatojejunostomy as palliative treatment for irresectable malignant tumors of the liver hilum. Ann Surg 229:181–186
Jarnagin W-R, Fong Y, DeMatteo R-P, Gonen M, Burke E-C, Bodniewicz BSJ, Youssef BAM, Klimstra D, Blumgart L-H (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517
Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Shimizu Y, Kato A, Nakamura S, Omoto H, Nakajima N, Kimura F, Suwa T (1998) Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? Surgery 123:131–136
Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7:155–162
Mittal B, Deutsch M, Iwatsuki S (1985) Primary cancers of the extrahepatic biliary passages. Int J Radiat Oncol Biol Phys 11:849–855
Kawarada Y, Isaji S, Taoka H, Tabata M, Das B-C, Yokoi H (1999) S4a+S5 with caudate lobe (S1) resection using the Taj Mahal liver parenchymal resection for carcinoma of the biliary tract. J Gastrointest Surg 3:369–373
Bismuth H (1982) Surgical anatomy and anatomical surgery of the liver. World J Surg 6:3–9
Neuhaus P, Jonas S, Bechstein W-O, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–818
Scheele J, Altendorf-Hofmann A, Stangl R, Schmidt K (1996) Surgical resection of colorectal liver metastases: Gold standard for solitary and radically resectable lesions. Swiss Surg (Suppl) 4:4–17
Iwasaki Y, Okamura T, Ozaki A, Todoroki T, Takase Y, Ohara K, Nishimura A, Otsu H (1986) Surgical treatment for carcinoma at the confluence of the major hepatic ducts. Surg Gynecol Obstet 162:457–464
Mizumoto R, Kawarada Y, Suzuki H (1986) Surgical treatment of hilar carcinoma of the bile duct. Surg Gynecol Obstet 162:153–158
Makuuchi M, Thai BL, Takayasu K, et al (1990) Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 107:521–527
Hatfield ARW, Tobias R, Terblanche J, et al (1982) Preoperative external biliary drainage in obstructive jaundice: a prospective controlled clinical trial. Lancet 2:896–899
Hintze R-E, Abou-Rebyeh H, Adler A, Veltzke-Schlieker W, Felix R, Wiedenmann B (2001) Magnetic resonance cholangiopancreatography-guided unilateral endoscopic stent placement for Klatskin tumors. Gastrointest Endosc 53:40–46
Vogl T-J, Balzer J-O, Dette K, Hintze R, Pegios W, Maurer J, Keck H, Neuhaus P, Felix R (1998) Initially unresectable hilar cholangiocarcinoma: hepatic regeneration after transarterial embolization. Radiology 208:217–222
Bismuth H, Nakache R, Diamond T (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215:31–38
Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M (1999) Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg 230:663–671
Kitagawa Y, Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Nimura Y (2001) Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 233:385–392
Tojima Y, Nagino M, Ebata T, Uesaka K, Kamiya J, Nimura Y (2003) Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma. Ann Surg 237:201–207
Izbicki J-R, Hosch S-B, Pichlmeier U, Rehders A, Busch C, Niendorf A, Passlick B, Broelsch C-E, Pantel K (1997) Prognostic value of immunohistochemically identifiable tumor cells in lymph nodes of patients with completely resected esophageal cancer. N Engl J Med 337:1188–1194
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Neuhaus, P., Jonas, S., Settmacher, U. et al. Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbecks Arch Surg 388, 194–200 (2003). https://doi.org/10.1007/s00423-003-0383-5
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DOI: https://doi.org/10.1007/s00423-003-0383-5