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Partial or total resection of the biliary tract — Surgical strategies for hilar cholangiocarcinoma

Partielle oder totale Resektion der Gallenwege — chirurgische Behandlungsstrategien beim zentralen Gallengangskarzinom

  • Main Topics: Liver Resection Or Transplantation — New Therapeutic Concepts
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Summary

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 80 resections of hilar cholangiocarcinomas were reviewed retrospectively.

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%. Curative resection and 5-year survival rates after additional hemihepatectomy generally do not exceed 65% and 25% in the more promising reports, respectively. In our series, the best 5-year survival rate was achieved after right trisegmentectomy with 59%. After conventional liver transplantation, 5-year survivors can only exceptionally be observed. Although extended bile duct resection or abdominal organ cluster transplantation may significantly increase the rate of formally curative resections, long term survival is still disappointing.

Conclusions: In our hands, right trisegmentectomy will provide the most pronounced benefit, if this procedure is applicable with respect to tumor extension and functioning hepatic reserve. Extended bile duct resections cannot be evaluated definitely at this stage. However, patterns of recurrence clearly demonstrate the need for adjuvant treatment protocols.

Zusammenfassung

Grundlagen: Resektionen stellen die einzigen potentiell kurativen Therapieoptionen beim zentralen Gallengangskarzinom dar. In den vergangenen 20 Jahren konnte eine Zunahme der Radikalität in der chirurgischen Therapie beobachtet werden, ohne daß einheitliche Therapiekonzepte bestünden.

Methodik: Retrospektive Untersuchung der Literatur sowie unserer eigenen Erfahrung nach 80 Resektionen zentraler Gallengangskarzinome.

Ergebnisse: Formal kurative Resektabilität stellt den wichtigsten Prognosefaktor dar. Hilusresektionen als Verfahren mit der geringsten Radikalität sind in weniger als 50% der Fälle formal kurativ. Die Raten formal kurativer Resektionen sowie des 5-Jahres-Überlebens nach zusätzlicher Hemihepatektomie übersteigen auch in günstigeren Serien in der Regel 65% bzw. 25% nicht. Im eigenen Krankengut wurde mit 59% die höchste 5-Jahres-Überlebensrate nach rechtsseitiger Trisegmentektomie beobachtet. Nach konventioneller Lebertransplantation kommt es nur in Ausnahmefällen zu einem Langzeitüberleben. Erweiterte Gallengangsresektionen sowie auch abdominelle „Cluster-Transplantationen“ können zwar die Rate formal kurativer Resektionen signifikant steigern, führen aber nicht zu einer höheren 5-Jahres-Überlebensrate.

Schlußfolgerungen: Nach unserer Erfahrung können die günstigsten Ergebnisse nach Trisegmentektomien beobachtet werden, wenn Tumorausmaß oder Parenchymreserve diese Verfahrenswahl zulassen. Erweiterte Gallengangsresektionen können derzeit nicht abschließend beurteilt werden. Das Rezidivmuster verdeutlicht die Notwendigkeit adjuvanter Therapieansätze.

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Authors and Affiliations

  1. Department of Internal Medicine, Gastroenterology/Hepatology, Virchow Clinic, Humboldt University, Berlin, Germany

    W. Veltzke & R. Hintze

  2. Department of Radiodiagnostics, Virchow Clinic, Humboldt University, Berlin, Germany

    T. Vogl

  3. Department of Surgery, Virchow Clinic, Humboldt University, Augustenburger Platz 1, D-13353, Berlin, Germany

    S. Jonas M.D., W. O. Bechstein, H. Keck & P. Neuhaus

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  1. S. Jonas M.D.
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  2. W. O. Bechstein
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  3. H. Keck
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  4. W. Veltzke
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  7. P. Neuhaus
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Correspondence to S. Jonas M.D..

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Jonas, S., Bechstein, W.O., Keck, H. et al. Partial or total resection of the biliary tract — Surgical strategies for hilar cholangiocarcinoma. Acta Chir Austriaca 30, 211–214 (1998). https://doi.org/10.1007/BF02620207

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