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Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution

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Abstract

Purpose

This study aimed to examine the changes in procedures for hilar cholangiocarcinoma (HC) surgery and patient survival following HC surgery over a 40-year period.

Methods

Between 1974 and 2014, 239 consecutive patients underwent surgery for HC. The changes in perioperative therapy and short- and long-term surgical outcomes were evaluated.

Results

The rates of major hepatectomy (in particular, right hepatectomy) and R0 resection significantly increased. Blood loss, transfusion rate, morbidity, and surgical mortality all significantly decreased. The 5-year disease-specific survival was 9.29 % (n = 38) in 1974–1988, 41.1 % (n = 88) in 1989–2003 and 55.6 % (n = 57) in 2004–2008 (p = 0.0001: 1974–1988 vs 1989–2003, p < 0.0001:1974–1988 vs 2004–2008, p = 0.076: 1989–2003 vs 2004–2008). According to a multivariate analysis, Bismuth classification IV (HR vs I, 2.86), period 1989–2003 (HR vs 1974–1988, 0.31), 2004–2008 (HR vs 1974–1988, 0.26), and R1 or R2 resection (HR vs R0, 2.22) were independent prognostic factors.

Conclusion

The surgical outcomes for HC over the 40-year period clearly improved as a result of aggressive surgery and progress in surgical techniques, perioperative management, and diagnostic tools.

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Abbreviations

HC:

Hilar cholangiocarcinoma

HR:

Hazard ratio

MST:

Median survival time

OS:

Overall survival

DSS:

Disease-specific survival

CT:

Computed tomography

MDCT:

Multidetector row CT

ENBD:

Endoscopic nasobiliary drainage

PTBD:

Percutaneous transhepatic biliary drainage

PVE:

Portal vein embolization

ICG:

Indocyanine green

LTB:

Level of total bilirubin in the bile from a predicted remnant liver

UICC:

International Union against Cancer

CIS:

Carcinoma in situ

CI:

Confidence interval

NA:

Not applicable

NS:

Not significant

M:

Month

LN:

Lymph node

HM:

Hepatic margin

DM:

Distal margin

HPD:

Hepatectomy with pancreatoduodenectomy

R2:

Right hepatectomy with caudate lobectomy (S1) and bile duct resection (BDR)

R3:

Right trisectionectomy with S1 and BDR

L2:

Left hepatectomy with S1 and BDR

L3:

Left trisectionectomy with S1 and BDR

CB:

Central bisegmentectomy with S1 and BDR

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Acknowledgments

The authors would like to thank Prof. Naohito Yamaguchi (Department of Public Health, Tokyo Women’s Medical University), who performed a statistical review of this manuscript.

Conflict of interest

All authors have no conflicts of interest to declare in association with this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Ryota Higuchi, Takehisa Yazawa, Hideki Kajiyama, Tatsuya Yoshikawa, Ken Takasaki & Masakazu Yamamoto

  2. Ebara Hospital, Tokyo, Japan

    Takehiro Ota

  3. Division of Gastroenterological Surgery, Department of Surgery, Yachiyo Medical Center, Tokyo Women’s Medical University, Chiba, Japan

    Tatsuo Araida

  4. Department of Pathology, and International Research and Educational Institute for Integrated Medical Sciences, Tokyo Women’s Medical University, Tokyo, Japan

    Toru Furukawa

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  1. Ryota Higuchi
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  2. Takehiro Ota
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  7. Tatsuya Yoshikawa
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  8. Ken Takasaki
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  9. Masakazu Yamamoto
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Corresponding author

Correspondence to Masakazu Yamamoto.

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Higuchi, R., Ota, T., Yazawa, T. et al. Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution. Surg Today 46, 74–83 (2016). https://doi.org/10.1007/s00595-015-1119-1

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  • DOI: https://doi.org/10.1007/s00595-015-1119-1

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