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Improved Survival Following Right Trisectionectomy with Caudate Lobectomy without Operative Mortality: Surgical Treatment for Hilar Cholangiocarcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

We conducted this study to assess the safety of performing right trisectionectomy with caudate lobectomy for hilar cholangiocarcinoma by analyzing postoperative mortality and morbidity, and to evaluate the effect of such procedure on pathological curability and long-term overall survival.

Methods

A retrospective clinicopathological analysis was performed for 16 hilar cholangiocarcinoma patients who underwent right trisectionectomy with caudate lobectomy from June 1999 to April 2003. The median follow-up period was 36.9 months. The preoperative Bismuth–Corlette type was type II in four patients, type IIIA in 10 patients, and type IV in two patients.

Results

The median liver volume after hepatic resection was 21.9% of the total liver volume. Postoperative complications including one chronic liver failure developed in 12 patients, but no in-hospital deaths occurred. A postoperative pathological examination showed a cancer free margin in all of the proximal resection sites, although three cases had carcinoma in situ (CIS) lesions in the distal margin that were confirmed during surgery. The 1-, 3-, and 5-year overall survival rates were 94.1%, 64.2%, and 64.2%, respectively.

Conclusion

We obtained excellent survival rates without any in-hospital deaths following right trisectionectomy with caudate lobectomy. This procedure may be an effective surgical procedure that can be executed to achieve low mortality rate and high pathological curability for hilar cholangiocarcinomas, except for Bismuth type IIIB.

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References

  1. Longmire WP, McArthur MS, Bastounis EA, Hiatt J. Carcinoma of the extrahepatic biliary tract. Ann Surg 1973;178:333–345.

    Article  PubMed  CAS  Google Scholar 

  2. Tompkins RK, Thomas D, Wile A, Longmire WP Jr. Prognostic factors in bile duct carcinoma: analysis of 96 cases. Ann Surg 1981;194:447–457.

    Article  PubMed  CAS  Google Scholar 

  3. Lai EC, Tompkins RK, Mann LL, Roslyn JJ. Proximal bile duct cancer. Quality of survival. Ann Surg 1987;205:111–118.

    Article  PubMed  CAS  Google Scholar 

  4. Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg 1990;14:535–543. discussion 544.

    Article  PubMed  CAS  Google Scholar 

  5. Baer HU, Stain SC, Dennison AR, Eggers B, Blumgart LH. Improvements in survival by aggressive resections of hilar cholangiocarcinoma. Ann Surg 1993;217:20–27.

    Article  PubMed  CAS  Google Scholar 

  6. Washburn WK, Lewis WD, Jenkins RL. Aggressive surgical resection for cholangiocarcinoma. Arch Surg 1995;130:270–276.

    PubMed  CAS  Google Scholar 

  7. Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 2000;7:155–162.

    Article  PubMed  CAS  Google Scholar 

  8. Launois B, Terblanche J, Lakehal M, Catheline JM, Bardaxoglou E, Landen S, Campion JP, Sutherland F, Meunier B. Proximal bile duct cancer: high resectability rate and 5-year survival. Ann Surg 1999;230:266–275.

    Article  PubMed  CAS  Google Scholar 

  9. Saldinger PF, Blumgart LH. Resection of hilar cholangiocarcinoma—a European and United States experience. J Hepatobiliary Pancreat Surg 2000;7:111–114.

    Article  PubMed  CAS  Google Scholar 

  10. Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, Youssef BM, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 2001;234:507–517. discussion 517–509.

    Article  PubMed  CAS  Google Scholar 

  11. Havlik R, Sbisa E, Tullo A, Kelly MD, Mitry RR, Jiao LR, Mansour MR, Honda K, Habib NA. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors. Hepatogastroenterology 2000;47:927–931.

    PubMed  CAS  Google Scholar 

  12. Tabata M, Kawarada Y, Yokoi H, Higashiguchi T, Isaji S. Surgical treatment for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2000;7:148–154.

    Article  PubMed  CAS  Google Scholar 

  13. Gazzaniga GM, Filauro M, Bagarolo C, Mori L. Surgery for hilar cholangiocarcinoma: an Italian experience. J Hepatobiliary Pancreat Surg 2000;7:122–127.

    Article  PubMed  CAS  Google Scholar 

  14. Tsao JI, Nimura Y, Kamiya J, Hayakawa N, Kondo S, Nagino M, Miyachi M, Kanai M, Uesaka K, Oda K, Rossi RL, Braasch JW, Dugan JM. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience. Ann Surg 2000;232:166–174.

    Article  PubMed  CAS  Google Scholar 

  15. Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 2003;238:720–727.

    Article  PubMed  Google Scholar 

  16. Neuhaus P, Jonas S, Settmacher U, Thelen A, Benckert C, Lopez-Hanninen E, Hintze RE. Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbeck’s Arch Surg 2003;388:194–200.

    Article  Google Scholar 

  17. 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;31:533–539.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999;230:808–818. discussion 819.

    Article  PubMed  CAS  Google Scholar 

  20. Su CH, Tsay SH, Wu CC, Shyr YM, King KL, Lee CH, Lui WY, Liu TJ, P’Eng FK. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg 1996;223:384–394.

    Article  PubMed  CAS  Google Scholar 

  21. 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;230:663–671.

    Article  PubMed  CAS  Google Scholar 

  22. Gerhards MF, van Gulik TM, de Wit LT, Obertop H, Gouma DJ. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma—a single center experience. Surgery 2000;127:395–404.

    Article  PubMed  CAS  Google Scholar 

  23. Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Kanai M, Nimura Y. Complications of hepatectomy for hilar cholangiocarcinoma. World J Surg 2001;25:1277–1283.

    Article  PubMed  CAS  Google Scholar 

  24. Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997;26:1176–1181.

    PubMed  CAS  Google Scholar 

  25. Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, Hicks M, Alsfasser G, Lauwers G, Hawkins IF, Caridi J. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 2000;127:512–519.

    Article  PubMed  CAS  Google Scholar 

  26. Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002;137:675–680. discussion 680–681.

    Article  PubMed  Google Scholar 

  27. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518–526.

    PubMed  CAS  Google Scholar 

  28. Hayashi S, Miyazaki M, Kondo Y, Nakajima N. Invasive growth patterns of hepatic hilar ductal carcinoma. A histologic analysis of 18 surgical cases. Cancer 1994;73:2922–2929.

    Article  PubMed  CAS  Google Scholar 

  29. Bhuiya MR, Nimura Y, Kamiya J, Kondo S, Fukata S, Hayakawa N, Shionoya S. Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg 1992;215:344–349.

    Article  PubMed  CAS  Google Scholar 

  30. D’Angelica MI, Jarnagin WR, Blumgart LH. Resectable hilar cholangiocarcinoma: surgical treatment and long-term outcome. Surg Today 2004;34:885–890.

    Article  PubMed  Google Scholar 

  31. Sakamoto E, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, Kanai M, Miyachi M, Uesaka K. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg 1998;227:405–411.

    Article  PubMed  CAS  Google Scholar 

  32. Bengmark S, Ekberg H, Evander A, Klofver-Stahl B, Tranberg KG. Major liver resection for hilar cholangiocarcinoma. Ann Surg 1988;207:120–125.

    Article  PubMed  CAS  Google Scholar 

  33. Nagino M, Nimura Y, Kamiya J, Kanai M, Uesaka K, Hayakawa N, Yamamoto H, Kondo S, Nishio H. Segmental liver resections for hilar cholangiocarcinoma. Hepatogastroenterology 1998;45:7–13.

    PubMed  CAS  Google Scholar 

  34. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunven P, Yamazaki S, Hasegawa H, Ozaki H. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990;107:521–527.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  36. Makuuchi M, Takayama T, Gunven P, Kosuge T, Yamazaki S, Hasegawa H. Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients. World J Surg 1989;13:644–648.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Soon Chun Hyang Bucheon Hospital, Bucheon, Korea

    Jun Chul Chung

  2. Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea

    Kyung Tae Kang & Sang Bum Kim

  3. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea

    Kwang Yeol Paik & Dong Wook Choi

Authors
  1. Kwang Yeol Paik
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  2. Dong Wook Choi
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Correspondence to Dong Wook Choi.

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Paik, K.Y., Choi, D.W., Chung, J.C. et al. Improved Survival Following Right Trisectionectomy with Caudate Lobectomy without Operative Mortality: Surgical Treatment for Hilar Cholangiocarcinoma. J Gastrointest Surg 12, 1268–1274 (2008). https://doi.org/10.1007/s11605-008-0503-1

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