Skip to main content

Advertisement

SpringerLink
Log in

Impact of Combined Vascular Resection and Reconstruction in Patients with Advanced Perihilar Cholangiocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Perihilar cholangiocarcinoma often involves the adjacent vasculature, including the portal vein and hepatic artery. Combined vascular resection and reconstruction of the portal vein is more common than vascular resection and reconstruction of the hepatic artery. Herein, we aimed to elucidate the long-term outcomes in patients who underwent vascular resection and reconstruction for perihilar cholangiocarcinoma.

Methods

Between January 2004 and December 2020, 106 patients with perihilar cholangiocarcinoma were grouped into the no resection (n = 58), resection-portal vein (n = 31), and resection-hepatic artery with or without that of portal vein (n = 17) groups.

Results

There were no significant differences in morbidity and mortality between the three groups. The resection-portal vein and resection-hepatic artery groups had a significantly higher number of advanced tumors than the no resection group, but no significant differences were detected in the rates of lymph node metastasis and R0 resection between the three groups. The 5-year disease-specific survival in the resection-portal vein (37.6%) and resection-hepatic artery (26.9%) groups were poorer than that in the no resection group (47.8%), although the former groups had a significantly better prognosis than the latter group (7.0%). Multivariate analysis identified high preoperative carcinoembryonic antigen level (>5.7 ng/mL), intrahepatic metastasis, and non-R0 resection as independent poor prognostic factors.

Conclusion

Although the perioperative course in the resection-portal vein and hepatic artery groups was similar to that in the no resection group, the long-term prognoses were poor in the resection-portal vein and hepatic artery groups. Pre- and postoperative multidisciplinary therapy is required for patients with vascular resection and reconstruction.

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. Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 2013;258:129-140.

    Article  PubMed  Google Scholar 

  2. Kawarada Y, Das BC, Taoka H. Anatomy of the hepatic hilar area: the plate system. J Hepatobiliary Pancreat Surg. 2000;7:580-6.

    Article  CAS  PubMed  Google Scholar 

  3. Abbas S, Sandroussi C. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma. HPB (Oxford) 2013;15:492-503.

    Article  Google Scholar 

  4. Bai T, Chen J, Xie ZB, Ma L, Liu JJ, Zhu SL, Wu FX, Li LQ. Combined portal vein resection for hilar cholangiocarcinoma. Int J Clin Exp Med 2015;8:21044-21052.

    CAS  PubMed Central  PubMed  Google Scholar 

  5. Wu XS, Dong P, Gu J, Li ML, Wu WG, Lu JH, Mu JS, Ding QC, Zhang L, Ding Q, Weng H, Liu YB. Combined portal vein resection for hilar cholangiocarcinoma: a meta-analysis of comparative studies. J Gastrointest Surg 2013;17:1107-1115.

    Article  PubMed  Google Scholar 

  6. Chen W, Ke K, Chen YL. Combined portal vein resection in the treatment of hilar cholangiocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol 2014;40:489-495.

    Article  CAS  PubMed  Google Scholar 

  7. Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, Yoshidome H, Yoshitomi H, Furukawa K, Nozawa S. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 2007;141:581-588.

    Article  PubMed  Google Scholar 

  8. Kuriyama N, Usui M, Gyoten K, Hayasaki A, Fujii T, Iizawa Y, Kato H, Murata Y, Tanemura A, Kishiwada M, Sakurai H, Mizno S, Isaji S. Neoadjuvant chemotherapy followed by curative-intent surgery for perihilar cholangiocarcinoma based on its anatomical resectability classification and lymph node status. BMC Cancer 2020;20:405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kuriyama N, Isaji S, Tanemura A, Iizawa Y, Kato H, Murata Y, Azumi Y, Kishiwada M, Mizuno S, Usui M, Sakurai H. Transhepatic hilar approach for perihilar cholangiocarcinoma: significance of early judgment of resectability and safe vascular reconstruction. J Gastrointest Surg 2017;21:590-599.

    Article  PubMed  Google Scholar 

  10. Ikeyama T, Nagino M, Oda K, Ebata T, Nishio H, Nimura Y. Surgical approach to bismuth Type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg 2007;246:1052-1057.

    Article  PubMed  Google Scholar 

  11. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999;230:808-818.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. 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.

    PubMed Central  PubMed  Google Scholar 

  13. Sumiyoshi T, Shima Y, Okabayashi T, Kozuki A, Hata Y, Noda Y, Kouno M, Miyagawa K, Tokorodani R, Saisaka Y, Tokumaru T, Nakamura T, Morita S. Liver function assessment using 99mTc-GSA single-photon emission computed tomography (SPECT)/CT fusion imaging in hilar bile duct cancer: A retrospective study. Surgery 2016;160:118-126.

    Article  PubMed  Google Scholar 

  14. Yokoyama Y, Nishio H, Ebata T, Igami T, Sugawara G, Nagino M. Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br J Surg 2010;97:1260-1268.

    Article  CAS  PubMed  Google Scholar 

  15. Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otsuka M, Kato A, Hideyuki Y, Nozawa S, Furukawa K, Mituhashi N, Takeuchi D, Suda K, Takano S. Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases. Am J Surg 2008;196:125-129.

    Article  PubMed  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196.

    Article  PubMed  Google Scholar 

  17. Nagino M. Perihilar cholangiocarcinoma: a surgeon’s viewpoint on current topics. J Gastroenterol 2012;47:1165-1176.

    Article  PubMed  Google Scholar 

  18. Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, Nishikimi N, Kamei Y. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 2010;252:115-23.

    Article  PubMed  Google Scholar 

  19. Matsuyama R, Mori R, Ota Y, Homma Y, Kumamoto T, Takeda K, Norioka D, Maegawa J, Endo I. Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol 2016;23:475-484.

    Article  PubMed  Google Scholar 

  20. Hu HJ, Jin YW, Zhou RX, Shrestha A, Ma WJ, Yang Q, Wang JK, Liu F, Cheng NS, Li FY. Hepatic artery resection for bismuth type III and IV hilar cholangiocarcinoma: is reconstruction always required? J Gastrointest Surg 2018;22:1204-1212.

    Article  PubMed  Google Scholar 

  21. Mizuno T, Ebata T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, Watanabe N, Kamei Y, Nagino M. Combined vascular resection for locally advanced perihilar cholangiocarcinoma. Ann Surg 2020. https://doi.org/10.1097/SLA.0000000000004322.

  22. Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, Kim KH, Ahn CS, Kim MH, Lee SK, Sung KB, Ko GY. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asian experience. J Hepatobiliary Pancreat Sci 2010;17:476-489.

    Article  PubMed  Google Scholar 

  23. Hu HJ, Mao H, Shrestha A, Tan YQ, Ma WJ, Yang Q, Wang JK, Cheng NS, Li FY. Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: a single-institution experience in China. World J Gastroenterol 2016;22:2601-2610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Higuchi R, Yazawa T, Uemura S, Izumo W, Ota T, Kiyohara K, Furukawa T, Egawa H, Yamamoto M. Surgical outcomes for perihilar cholangiocarcinoma with vascular invasion. J Gastrointest Surg 2019;23:1443-1453.

    Article  PubMed  Google Scholar 

  25. Loosen SH, Roderburg C, Kauertz KL, Koch A, Vucur M, Schneider AT, Binnebösel M, Ulmer TF, Lurje G, Schoening W, Tacke F, Trautwein C, Longerich T, Dejong CH, Neumann UP, Luedde T. CEA but not CA19-9 is an independent prognostic factor in patients undergoing resection of cholangiocarcinoma. Sci Rep 2017;7:16975.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ito T, Kuriyama N, Kozuka Y, Komatsubara H, Ichikawa K, Noguchi D, Hayasaki A, Fujii T, Iizawa Y, Kato H, Tanemura A, Murata Y, Kishiwada M, Mizuno S, Usui M, Sakurai H, Isaji S. High tumor budding is a strong predictor of poor prognosis in the resected perihilar cholangiocarcinoma patients regardless of neoadjuvant therapy, showing survival similar to those without resection. BMC Cancer 2020;12;20:209.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan

    Naohisa Kuriyama, Haruna Komatsubara, Yuki Nakagawa, Koki Maeda, Toru Shinkai, Daisuke Noguchi, Takahiro Ito, Kazuyuki Gyoten, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada, Hiroyuki Sakurai & Shugo Mizuno

Authors
  1. Naohisa Kuriyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haruna Komatsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuki Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koki Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toru Shinkai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daisuke Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takahiro Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuyuki Gyoten
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Aoi Hayasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takehiro Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yusuke Iizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasuhiro Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Akihiro Tanemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masashi Kishiwada
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Hiroyuki Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Shugo Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design of work: Naohisa Kuriyama, Masashi Kishiwada, Hiroyuki Sakurai, Shugo Mizuno.

Acquisition of data: Naohisa Kuriyama, Haruna Komatsubara, Yuki Nakagawa, Koki Maeda, Toru Shinkai, Daisuke Noguchi, Takahiro Ito, Kazuyuki Gyoten, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Akihiro Tanemura.

Data analysis and interpretation: All authors participated in critically revising the manuscript for important intellectual content. All authors approved of the final version to be published and agreed to be accountable for all aspects of the work and ensured that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

All authors have read and approved the manuscript.

Corresponding author

Correspondence to Naohisa Kuriyama.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuriyama, N., Komatsubara, H., Nakagawa, Y. et al. Impact of Combined Vascular Resection and Reconstruction in Patients with Advanced Perihilar Cholangiocarcinoma. J Gastrointest Surg 25, 3108–3118 (2021). https://doi.org/10.1007/s11605-021-05004-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-021-05004-2

Keywords

Search

Navigation