World Journal of Surgery

, Volume 37, Issue 3, pp 614–621

One-stage Resection for Bismuth Type IV Hilar Cholangiocarcinoma with High Hilar Resection and Parenchyma-preserving Strategies: A Cohort Study

  • Jing Wang Tan
  • Ben Shun Hu
  • Ya Juan Chu
  • Yun Chang Tan
  • Xu Ji
  • Ke Chen
  • Xiang Min Ding
  • Aiqun Zhang
  • Fei Chen
  • Jia Hong Dong
Article

Abstract

Background

Bismuth type IV hilar cholangiocarcinoma (HC) tumors are usually considered unresectable. The strategies of high hilar resection while preserving liver parenchyma can achieve potentially one-stage curative resection for this condition. The aim of the present study was to investigate the feasibility and safety of available strategies.

Methods

Fifty-one consecutive patients with bismuth type IV HC who underwent one-stage resection were retrospectively reviewed with regard to curative resection rate, remnant liver volume, morbidity, mortality, and survival time.

Results

The total median survival time was 29 months. The R0 (curative resection) rate was 57.8 %. The ratio of the remnant liver volume (RLV) to the standard liver volume (SLV) ranged from 35.0 to 60.6 %, with a mean of 44.5 %. The in-hospital mortality and morbidity rates were 3.9 and 37.2 %, respectively. In the R0 patients’ survival, there was not a significant difference between bilioenteric anastomosis and hepatoenteric anastomosis (P = 0.714).

Conclusions

Combined caudate lobe and high hilar resection (CCHR) is technically safe and oncologically justifiable and could be adopted with a high cure rate as a one-stage resection procedure for most patients with Bismuth type IV HC whose total bilirubin level is less than 20 mg/L and whose direct bilirubin is more than 60 % of total bilirubin.

References

  1. 1.
    Paul A, Kaiser GM, Molmenti EP et al (2011) Klatskin tumors and the accuracy of the Bismuth–Corlette classification. Am Surg 77:1695–1699PubMedGoogle Scholar
  2. 2.
    Jarnagin WR, Fong Y, DeMatteo RP et al (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–519PubMedCrossRefGoogle Scholar
  3. 3.
    Silva MA, Tekin K, Aytekin F et al (2005) Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol 31:533–539PubMedCrossRefGoogle Scholar
  4. 4.
    Jarnagin WR, Bowne W, Klimstra DS et al (2005) Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma. Ann Surg 241:703–714PubMedCrossRefGoogle Scholar
  5. 5.
    Grandadam S, Compagnon P, Arnaud A et al (2010) Role of preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma type III. Ann Surg Oncol 17:3155–3161PubMedCrossRefGoogle Scholar
  6. 6.
    Tabata M, Kawarada Y, Yokoi H et al (2000) Surgical treatment for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 7:148–154PubMedCrossRefGoogle Scholar
  7. 7.
    Nimura Y, Kamiya J, Kondo S et al (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7:155–162PubMedCrossRefGoogle Scholar
  8. 8.
    Ito F, Cho CS, Rikkers LF et al (2009) Hilar cholangiocarcinoma: current management. Ann Surg 250:210–218PubMedCrossRefGoogle Scholar
  9. 9.
    Kow AW, Wook CD, Song SC et al (2012) Role of caudate lobectomy in type III A and III B hilar cholangiocarcinoma: a 15-year experience in a tertiary institution. World J Surg 36:1112. doi:10.1007/s00268-012-1497-0 PubMedCrossRefGoogle Scholar
  10. 10.
    Hasegawa S, Ikai I, Fujii H et al (2007) Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications. World J Surg 31:1256. doi:10.1007/s00268-007-9001 PubMedCrossRefGoogle Scholar
  11. 11.
    Hatfield ARW, Tobias R, Terblanche J et al (1982) Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet 2(8304):896–899PubMedCrossRefGoogle Scholar
  12. 12.
    McPherson GA, Benjamin IS, Hodgson HJ et al (1984) Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg 71:371–375PubMedCrossRefGoogle Scholar
  13. 13.
    Pitt HA, Gomes AS, Lois JF et al (1985) Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 201:545–553PubMedCrossRefGoogle Scholar
  14. 14.
    van der Gaag NA, Rauws EAJ, van Eijck CHJ et al (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362:129–137PubMedCrossRefGoogle Scholar
  15. 15.
    Neuhaus P, Jonas S, Bechstein WO et al (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–819 discussion 819PubMedCrossRefGoogle Scholar
  16. 16.
    Hemming AW, Reed AI, Howard RJ et al (2003) Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237:686–693 discussion 691PubMedGoogle Scholar
  17. 17.
    Abdalla EK, Barnett CC, Doherty D et al (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137:675–681 discussion 680PubMedCrossRefGoogle Scholar
  18. 18.
    Makuuchi M, Takayasu K, Takuma T (1984) Preoperative transcatheter embolization of the portalvenous branch for patients receiving extended lobectomy due to the bile duct carcinoma. J Jpn Soc Clin Surg 984:14–20Google Scholar
  19. 19.
    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 107:521–527PubMedGoogle Scholar
  20. 20.
    Watadani T, Akahane M, Yoshikawa T et al (2008) Preoperative assessment of hilar cholangiocarcinoma using multidetector-row CT: correlation with histopathological findings. Radiat Med 26:402–407PubMedCrossRefGoogle Scholar
  21. 21.
    Schwartz LH, Lefkowitz RA, Panicek DM et al (2003) Breath-hold magnetic resonance cholangiopancreatography in the evaluation of malignant pancreaticobiliary obstruction. J Comput Assist Tomogr 27:307–314PubMedCrossRefGoogle Scholar
  22. 22.
    Schindl MJ, Redhead DN, Fearon KC et al (2005) The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54:289–296PubMedCrossRefGoogle Scholar
  23. 23.
    Vauthey JN, Chaoui A, Do KA et al (2000) Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 127:512–519PubMedCrossRefGoogle Scholar
  24. 24.
    Clavien PA, Petrowsky H, DeOliveira ML et al (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356:1545–1559PubMedCrossRefGoogle Scholar
  25. 25.
    Paik KY, Choi DW, Chung JC et al (2008) Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma. J Gastrointest Surg 12:1268–1274PubMedCrossRefGoogle Scholar
  26. 26.
    Sakamoto E, Nimura Y, Hayakawa N et al (1998) The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg 227:405–411PubMedCrossRefGoogle Scholar
  27. 27.
    Kasai M (1974) Treatment of biliary atresia with special reference to hepatic porto-enterostomy and its modifications. Prog Pediatr Surg 6:5–52PubMedGoogle Scholar
  28. 28.
    Karakousis CP, Douglass HO Jr (1977) Hilar hepatojejunostomy in resection of carcinoma of the main hepatic duct junction. Surg Gynecol Obstet 8:245–248Google Scholar
  29. 29.
    Aydin U, Yedibela S, Yazici P et al (2008) A new technique of biliary reconstruction after “high hilar resection” of hilar cholangiocarcinoma with tumor extension to secondary and tertiary biliary radicals. Ann Surg Oncol 15:1871–1879PubMedCrossRefGoogle Scholar
  30. 30.
    Kondo S, Hirano S, Ambo Y et al (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101PubMedCrossRefGoogle Scholar
  31. 31.
    Hemming AW, Kim RD, Mekeel KL et al (2006) Portal vein resection for hilar cholangiocarcinoma. Am Surg 72:599–605 discussion 604PubMedGoogle Scholar
  32. 32.
    Ebata T, Nagino M, Kamiya J et al (2003) Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 238:720–727PubMedCrossRefGoogle Scholar
  33. 33.
    Gerhards MF, van Gulik TM, de Wit LT et al (2000) Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma—a single center experience. Surgery 127:395–404PubMedCrossRefGoogle Scholar
  34. 34.
    Hasse FM, van TH, Blumhardt G, Lohlein D (1998) What is the risk of resection of the right hepatic artery in resection of central bile duct carcinoma? Langenbecks Arch Chir Suppl Kongressbd 115:352–355 (in German)Google Scholar
  35. 35.
    Briceño J, Naranjo A, Ciria R et al (2008) Late hepatic artery pseudoaneurysm: a rare complication after resection of hilar cholangiocarcinoma. World J Gastroenterol 14:5920–5923PubMedCrossRefGoogle Scholar
  36. 36.
    Jarnagin WR, Burke E, Powers C et al (1998) Intrahepatic biliary enteric bypass provides effective palliation in selected patients with malignant obstruction at the hepatic duct confluence. Am J Surg 175:453–460PubMedCrossRefGoogle Scholar
  37. 37.
    Inal M, Akgul E, Aksungur E et al (2003) Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction. Complications, follow-up and reintervention in 154 patients. Acta Radiol 44:139–146PubMedCrossRefGoogle Scholar
  38. 38.
    Cheng JL, Bruno MJ, Bergman JJ et al (2002) Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents. Gastrointest Endosc 56:33–39PubMedCrossRefGoogle Scholar
  39. 39.
    Park J, Kim MH, Kim KP et al (2009) Natural history and prognostic factors of advanced cholangiocarcinoma without surgery, chemotherapy, or radiotherapy: a large-scale observational study. Gut Liver 3:298–305PubMedCrossRefGoogle Scholar
  40. 40.
    Ribero D, Amisano M, Tesoriere RL et al (2011) Additional resection of an intraoperative margin-positive proximal bile duct improves survival in patients with hilar cholangiocarcinoma. Ann Surg 254:776–781 (discussion 781)PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Jing Wang Tan
    • 1
  • Ben Shun Hu
    • 1
  • Ya Juan Chu
    • 2
  • Yun Chang Tan
    • 2
  • Xu Ji
    • 1
  • Ke Chen
    • 2
  • Xiang Min Ding
    • 2
  • Aiqun Zhang
    • 1
  • Fei Chen
    • 1
  • Jia Hong Dong
    • 1
  1. 1.PLA General Hospital, Institute of Hepatobiliary SurgeryBeijingPeople’s Republic of China
  2. 2.Hepatobiliary Surgery DepartmentNorthern Jiangsu People’s Hospital, Yangzhou UniversityYangzhouPeople’s Republic of China

Personalised recommendations