Skip to main content
SpringerLink
Log in

Major hepatectomy for perihilar cholangiocarcinoma

  • Topics
  • A new era of surgical treatment of hilar cholangiocarcinoma: comparison of leading Eastern and Western centers
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

Hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma involving the hepatic hilus are defined as “perihilar cholangiocarcinoma”. The principle of surgical treatment is hemi-hepatectomy or trisectionectomy of the liver, caudate lobectomy, and resection of the extrahepatic bile duct for complete resection of the tumor. The aim of this study was to review the outcomes of major hepatectomy for perihilar cholangiocarcinoma.

Methods

Using the Kaplan–Meier method and the Cox proportional hazards model, we analyzed the results in 125 patients with perihilar cholangiocarcinoma who had undergone major hepatectomy.

Results

Right hepatectomy, right trisectionectomy, left hepatectomy, and left trisectionectomy were performed in 66, 8, 49, and 2 patients, respectively. Curative resection was achieved in 79 patients (63.2%). Mortality and morbidity rates were 8.0 and 48.7%, respectively. The overall 1-, 3-, and 5-year survival rates of all patients were 73.2, 36.7, and 34.7%, respectively. The median survival was 26.8 months. Multivariate analysis showed that the independent prognostic factors for overall survival were gender, histopathological grading, curative resection, and American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) pT.

Conclusions

Major hepatectomy for perihilar cholangiocarcinoma was acceptable and showed satisfactory outcomes. For long-term survival in these patients, the surgeon should aim for complete resection of the tumor with negative margins.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7(2):155–62.

    Article  CAS  PubMed  Google Scholar 

  2. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230(6):808–18. discussion 19.

    Article  CAS  PubMed  Google Scholar 

  3. Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg. 1999;230(5):663–71.

    Article  CAS  PubMed  Google Scholar 

  4. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140(2):170–8.

    CAS  PubMed  Google Scholar 

  5. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  Google Scholar 

  6. Sano T, Shimada K, Sakamoto Y, Ojima H, Esaki M, Kosuge T. Prognosis of perihilar cholangiocarcinoma: hilar bile duct cancer versus intrahepatic cholangiocarcinoma involving the hepatic hilus. Ann Surg Oncol. 2008;15(2):590–9.

    Article  PubMed  Google Scholar 

  7. Ebata T, Kamiya J, Nishio H, Nagasaka T, Nimura Y, Nagino M. The concept of perihilar cholangiocarcinoma is valid. Br J Surg. 2009;96(8):926–34.

    Article  CAS  PubMed  Google Scholar 

  8. Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234(4):507–17. discussion 17–9.

    Article  CAS  PubMed  Google Scholar 

  9. Kawarada Y, Das BC, Naganuma T, Tabata M, Taoka H. Surgical treatment of hilar bile duct carcinoma: experience with 25 consecutive hepatectomies. J Gastrointest Surg. 2002;6(4):617–24.

    Article  PubMed  Google Scholar 

  10. Capussotti L, Muratore A, Polastri R, Ferrero A, Massucco P. Liver resection for hilar cholangiocarcinoma: in-hospital mortality and longterm survival. J Am Coll Surg. 2002;195(5):641–7.

    Article  PubMed  Google Scholar 

  11. Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003;238(1):84–92.

    Article  PubMed  Google Scholar 

  12. Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238(1):73–83.

    Article  PubMed  Google Scholar 

  13. Rea DJ, Munoz-Juarez M, Farnell MB, Donohue JH, Que FG, Crownhart B, et al. Major hepatic resection for hilar cholangiocarcinoma: analysis of 46 patients. Arch Surg. 2004;139(5):514–23. discussion 23-5.

    Article  PubMed  Google Scholar 

  14. Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg. 2004;240(1):95–101.

    Article  PubMed  Google Scholar 

  15. Ijitsma AJ, Appeltans BM, de Jong KP, Porte RJ, Peeters PM, Slooff MJ. Extrahepatic bile duct resection in combination with liver resection for hilar cholangiocarcinoma: a report of 42 cases. J Gastrointest Surg. 2004;8(6):686–94.

    Article  PubMed  Google Scholar 

  16. Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ. Surgical management of hilar cholangiocarcinoma. Ann Surg. 2005;241(5):693–9. discussion 9–702.

    Article  PubMed  Google Scholar 

  17. Lai EC, Lau WY. Aggressive surgical resection for hilar cholangiocarcinoma. ANZ J Surg. 2005;75(11):981–5.

    Article  PubMed  Google Scholar 

  18. Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience. HPB (Oxford). 2005;7(4):259–62.

    Google Scholar 

  19. Silva MA, Tekin K, Aytekin F, Bramhall SR, Buckels JA, Mirza DF. Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol. 2005;31(5):533–9.

    Article  CAS  PubMed  Google Scholar 

  20. Dinant S, Gerhards MF, Rauws EA, Busch OR, Gouma DJ, van Gulik TM. Improved outcome of resection of hilar cholangiocarcinoma (Klatskin tumor). Ann Surg Oncol. 2006;13(6):872–80.

    Article  PubMed  Google Scholar 

  21. Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg. 2006;244(2):240–7.

    Article  PubMed  Google Scholar 

  22. Witzigmann H, Berr F, Ringel U, Caca K, Uhlmann D, Schoppmeyer K, et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg. 2006;244(2):230–9.

    Article  PubMed  Google Scholar 

  23. Abdel Wahab M, Fathy O, Elghwalby N, Sultan A, Elebidy E, Abdalla T, et al. Resectability and prognostic factors after resection of hilar cholangiocarcinoma. Hepatogastroenterology. 2006;53(67):5–10.

    CAS  PubMed  Google Scholar 

  24. Cheng Q, Luo X, Zhang B, Jiang X, Yi B, Wu M. Predictive factors for prognosis of hilar cholangiocarcinoma: postresection radiotherapy improves survival. Eur J Surg Oncol. 2007;33(2):202–7.

    Article  CAS  PubMed  Google Scholar 

  25. Hasegawa S, Ikai I, Fujii H, Hatano E, Shimahara Y. Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications. World J Surg. 2007;31(6):1256–63.

    Article  PubMed  Google Scholar 

  26. Maeno H, Ono T, Yamanoi A, Nagasue N. Our experiences in surgical treatment for hilar cholangiocarcinoma. Hepatogastroenterology. 2007;54(75):669–73.

    PubMed  Google Scholar 

  27. Baton O, Azoulay D, Adam DV, Castaing D. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes. J Am Coll Surg. 2007;204(2):250–60.

    Article  PubMed  Google Scholar 

  28. Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery. 2007;141(5):581–8.

    Article  PubMed  Google Scholar 

  29. Otani K, Chijiiwa K, Kai M, Ohuchida J, Nagano M, Tsuchiya K, et al. Outcome of surgical treatment of hilar cholangiocarcinoma. J Gastrointest Surg. 2008;12(6):1033–40.

    Article  PubMed  Google Scholar 

  30. Hidalgo E, Asthana S, Nishio H, Wyatt J, Toogood GJ, Prasad KR, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience. Eur J Surg Oncol. 2008;34(7):787–94.

    CAS  PubMed  Google Scholar 

  31. Ito F, Agni R, Rettammel RJ, Been MJ, Cho CS, Mahvi DM, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence. Ann Surg. 2008;248(2):273–9.

    Article  PubMed  Google Scholar 

  32. Konstadoulakis MM, Roayaie S, Gomatos IP, Labow D, Fiel MI, Miller CM, et al. Aggressive surgical resection for hilar cholangiocarcinoma: is it justified? Audit of a single center’s experience. Am J Surg. 2008;196(2):160–9.

    Article  PubMed  Google Scholar 

  33. Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakamura H, et al. Gemcitabine-based adjuvant chemotherapy improves survival after aggressive surgery for hilar cholangiocarcinoma. J Gastrointest Surg. 2009;13(8):1470–9.

    Article  PubMed  Google Scholar 

  34. Unno M, Okumoto T, Katayose Y, Rikiyama T, Sato A, Motoi F, et al. Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg. 2007;14(5):434–40.

    Article  PubMed  Google Scholar 

  35. Sano T, Shimada K, Sakamoto Y, Esaki M, Kosuge T. Changing trends in surgical outcomes after major hepatobiliary resection for hilar cholangiocarcinoma: a single-center experience over 25 years. J Hepatobiliary Pancreat Surg. 2007;14(5):455–62.

    Article  PubMed  Google Scholar 

  36. Hemming AW, Kim RD, Mekeel KL, Fujita S, Reed AI, Foley DP, et al. Portal vein resection for hilar cholangiocarcinoma. Am Surg. 2006;72(7):599–604. discussion 5.

    PubMed  Google Scholar 

  37. Klempnauer J, Ridder GJ, von Wasielewski R, Werner M, Weimann A, Pichlmayr R. Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol. 1997;15(3):947–54.

    CAS  PubMed  Google Scholar 

  38. Todoroki T, Kawamoto T, Koike N, Takahashi H, Yoshida S, Kashiwagi H, et al. Radical resection of hilar bile duct carcinoma and predictors of survival. Br J Surg. 2000;87(3):306–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Brent Bell for reading the manuscript and Emiko Shibuya for technical assistance.

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Michiaki Unno, Yu Katayose, Toshiki Rikiyama, Hiroshi Yoshida, Kuniharu Yamamoto, Takanori Morikawa, Hiroki Hayashi, Fuyuhiko Motoi & Shinichi Egawa

Authors
  1. Michiaki Unno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Katayose
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshiki Rikiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kuniharu Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takanori Morikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroki Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fuyuhiko Motoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shinichi Egawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michiaki Unno.

About this article

Cite this article

Unno, M., Katayose, Y., Rikiyama, T. et al. Major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 17, 463–469 (2010). https://doi.org/10.1007/s00534-009-0206-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-009-0206-3

Keywords

Search

Navigation