Treatment and Prognostic Factor of TypeⅢHilar Cholangiocarcinoma in 170 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HUKai , YOUXiao-xiang , LIFu-yu , YEHui ,  JIANGLi-sheng

Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding?author：

JIANGLi-sheng, Email: jianglisheng57@163.com

Keywords：

TypeⅢhilar cholangiocarcinoma; Surgery; Palliative biliary drainage; Prognosis; Influence factor

DOI：

10.7507/1007-9424.20140068

Video：

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Objective To explore the treatment and prognostic factors of typeⅢhilar cholangiocarcinoma. Methods The data of 170 cases of typeⅢhilar cholangiocarcinoma treated in our hospital from Jan. 2002 to Dec. 2011 were retrospectively analyzed. Results Among these 170 patients of typeⅢhilar cholangiocarcinoma, 109 patients underwent surgical exploration in which 60 patients underwent resection and the remaining 49 patients were found unresectable and underwent U-tube or metallic stent drainage. Sixty one patients were preoperatively assessed as unresectable in which 14 patients underwent percutaneous transhepatic cholangial drainage and the remaining 47 patients refused any surgical intervention. Results of Cox proportional hazard model showed that residual tumor status (HR=4.621, 95% CI:1.907-11.199, P=0.001), lymph node metastasis (HR=2.792, 95% CI:1.393-5.598, P=0.004), and hepatectomy (HR=3.003, 95% CI:1.373-6.569, P=0.006) were independent prognostic factors which associated with patients in resection group. Besides, treatmentR0 resection (HR=0.177, 95% CI:0.081-0.035, P < 0.001), no treatment (HR=5.568, 95% CI:2.733-11.342, P < 0.001)] and vascular invasion (HR=1.667, 95% CI:1.152-2.412, P=0.007) were prognostic factors associated with all patients. Conclusions Treatment and vascular invasion are the most important predictors of prolonging survival associated with typeⅢhilar cholangiocarcinoma. Besides, R0 resection including hepatectomy without lymph nodes metastasis is feasible in the majority of patients with resectable hilar cholangiocarcinoma.

Citation： HUKai, YOUXiao-xiang, LIFu-yu, YEHui, JIANGLi-sheng. Treatment and Prognostic Factor of TypeⅢHilar Cholangiocarcinoma in 170 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 278-284. doi: 10.7507/1007-9424.20140068 Copy

1.	?Klatskin G. Adenocarrinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features[J]. Am J Med, 1965, 38:241-256.
2.	Grünhagen DJ, Dunne DF, Sturgess RP, et al. Metal stents:a bridge to surgery in hilar cholangiocarcinoma[J]. HPB (Oxford), 2013, 15(5):372-378.
3.	Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholan-giocarcinoma:the Leeds experience[J]. Eur J Surg Oncol, 2008, 34(7):787-794.
4.	Lee SG, Song GW, Hwang S, et al. Surgical treatment of hilar cholangiocarcinoma in the new era:the Asan experience[J]. J Hepatobiliary Pancreat Sci, 2010, 17(4):476-489.
5.	Hemming AW, Reed AI, Fujita S, et al. Surgical management of hilar cholangiocarcinoma[J]. Ann Surg, 2005, 241(5):693-699.
6.	Lee TY, Cheon YK, Shim CS, et al. Photodynamic therapy prolongs metal stent patency in patients with unresectable hilar cholangiocarcinoma[J]. World J Gastroenterol, 2012, 18(39):5589-5594.
7.	黃志強.肝門部膽管癌的外科治療與發展[J].中國普外基礎與臨床雜志, 2003, 10(5):425-428.
8.	Vladov N, Lukanova Ts, Takorov I, et al. Single centre experience with surgical treatment of hilar cholangiocarcinoma[J]. Chirurgia (Bucur), 2013, 108(3):299-303.
9.	嚴德輝, 劉志, 蔣純, 等.肝門膽管癌81例治療分析[J].中國普外基礎與臨床雜志, 2011, 18(9):978-981.
10.	Dumitrascu T, Chirita D, Ionescu M, et al. Resection for hilar cholangiocarcinoma:analysis of prognostic factors and the impact of systemic inflammation on long-term outcome[J]. J Gastrointest Surg, 2013, 17(5):913-924.
11.	Cheng QB, Yi B, Wang JH, et al. Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth typeⅢandⅣ[J]. Eur J Surg Oncol, 2012, 38(12):1197-1203.
12.	Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4:prognostic factors and longterm outcomes[J]. J Am Coll Surg, 2007, 204(2):250-260.
13.	Zaydfudim VM, Clark CJ, Kendrick ML, et al. Correlation of staging systems to survival in patients with resected hilar cholangiocarcinoma[J]. Am J Surg, 2013, 206(2):159-165.
14.	Ercolani G, Zanello M, Grazi GL, et al. Changes in the surgical approach to hilar cholangiocarcinoma during an 18-year period in a Western single center[J]. J Hepatobiliary Pancreat Sci, 2010, 17(3):329-337.
15.	van Gulik TM, Kloek JJ, Ruys AT, et al. Multidisciplinary management of hilar cholangiocarcinoma (Klatskin tumor):extended resection is associated with improved survival[J]. Eur J Surg Oncol, 2011, 37(1):65-71.
16.	Sano T, Shimada K, Sakamoto Y, et al. One hundred two conse-cutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality[J]. Ann Surg, 2006, 244(2):240-247.
17.	Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus[J]. World J Surg, 1990, 14(4):535-543.
18.	Gazzaniga GM, Ciferri E, Bagarolo C, et al. Primitive hepatic hilum neoplasm[J]. J Surg Oncol Suppl, 1993, 3:140-146.
19.	Miyazaki M, Kimura F, Shimizu H, et al. One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth typesⅡ, Ⅲ, Ⅳbetween 2001 and 2008[J]. J Hepatobiliary Pancreat Sci, 2010, 17(4):470-475.
20.	Kow AW, Wook CD, Song SC, et al. Role of caudate lobectomy in typeⅢA andⅢB hilar cholangiocarcinoma:a 15-year experience in a tertiary institution[J]. World J Surg, 2012, 36(5):1112-1121.
21.	Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma:results of an Italian multicenter analysis of 440 patients[J]. Arch Surg, 2012, 147(1):26-34.
22.	Chaib E, Ribeiro MA Jr, Silva Fde S, et al. Caudate lobectomy:tumor location, topographic classification, and technique using right-and left-sided approaches to the liver[J]. Am J Surg, 2008, 196(2):245-251.
23.	Hemming AW, Mekeel K, Khanna A, et al. Portal vein resection in management of hilar cholangiocarcinoma[J]. J Am Coll Surg, 2011, 212(4):604-613.
24.	Abbas S, Sandroussi C. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma[J]. HPB (Oxford), 2013, 15(7):492-503.
25.	Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the "new era":the Nagoya University expe-rience[J]. J Hepatobiliary Pancreat Sci, 2010, 17(4):449-454.
26.	Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma:audit of 110 patients who under-went regional and paraaortic node dissection[J]. Ann Surg, 2001, 233(3):385-392.

1. ?Klatskin G. Adenocarrinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features[J]. Am J Med, 1965, 38:241-256.
2. Grünhagen DJ, Dunne DF, Sturgess RP, et al. Metal stents:a bridge to surgery in hilar cholangiocarcinoma[J]. HPB (Oxford), 2013, 15(5):372-378.
3. Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholan-giocarcinoma:the Leeds experience[J]. Eur J Surg Oncol, 2008, 34(7):787-794.
4. Lee SG, Song GW, Hwang S, et al. Surgical treatment of hilar cholangiocarcinoma in the new era:the Asan experience[J]. J Hepatobiliary Pancreat Sci, 2010, 17(4):476-489.
5. Hemming AW, Reed AI, Fujita S, et al. Surgical management of hilar cholangiocarcinoma[J]. Ann Surg, 2005, 241(5):693-699.
6. Lee TY, Cheon YK, Shim CS, et al. Photodynamic therapy prolongs metal stent patency in patients with unresectable hilar cholangiocarcinoma[J]. World J Gastroenterol, 2012, 18(39):5589-5594.
7. 黃志強.肝門部膽管癌的外科治療與發展[J].中國普外基礎與臨床雜志, 2003, 10(5):425-428.
8. Vladov N, Lukanova Ts, Takorov I, et al. Single centre experience with surgical treatment of hilar cholangiocarcinoma[J]. Chirurgia (Bucur), 2013, 108(3):299-303.
9. 嚴德輝, 劉志, 蔣純, 等.肝門膽管癌81例治療分析[J].中國普外基礎與臨床雜志, 2011, 18(9):978-981.
10. Dumitrascu T, Chirita D, Ionescu M, et al. Resection for hilar cholangiocarcinoma:analysis of prognostic factors and the impact of systemic inflammation on long-term outcome[J]. J Gastrointest Surg, 2013, 17(5):913-924.
11. Cheng QB, Yi B, Wang JH, et al. Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth typeⅢandⅣ[J]. Eur J Surg Oncol, 2012, 38(12):1197-1203.
12. Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4:prognostic factors and longterm outcomes[J]. J Am Coll Surg, 2007, 204(2):250-260.
13. Zaydfudim VM, Clark CJ, Kendrick ML, et al. Correlation of staging systems to survival in patients with resected hilar cholangiocarcinoma[J]. Am J Surg, 2013, 206(2):159-165.
14. Ercolani G, Zanello M, Grazi GL, et al. Changes in the surgical approach to hilar cholangiocarcinoma during an 18-year period in a Western single center[J]. J Hepatobiliary Pancreat Sci, 2010, 17(3):329-337.
15. van Gulik TM, Kloek JJ, Ruys AT, et al. Multidisciplinary management of hilar cholangiocarcinoma (Klatskin tumor):extended resection is associated with improved survival[J]. Eur J Surg Oncol, 2011, 37(1):65-71.
16. Sano T, Shimada K, Sakamoto Y, et al. One hundred two conse-cutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality[J]. Ann Surg, 2006, 244(2):240-247.
17. Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus[J]. World J Surg, 1990, 14(4):535-543.
18. Gazzaniga GM, Ciferri E, Bagarolo C, et al. Primitive hepatic hilum neoplasm[J]. J Surg Oncol Suppl, 1993, 3:140-146.
19. Miyazaki M, Kimura F, Shimizu H, et al. One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth typesⅡ, Ⅲ, Ⅳbetween 2001 and 2008[J]. J Hepatobiliary Pancreat Sci, 2010, 17(4):470-475.
20. Kow AW, Wook CD, Song SC, et al. Role of caudate lobectomy in typeⅢA andⅢB hilar cholangiocarcinoma:a 15-year experience in a tertiary institution[J]. World J Surg, 2012, 36(5):1112-1121.
21. Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma:results of an Italian multicenter analysis of 440 patients[J]. Arch Surg, 2012, 147(1):26-34.
22. Chaib E, Ribeiro MA Jr, Silva Fde S, et al. Caudate lobectomy:tumor location, topographic classification, and technique using right-and left-sided approaches to the liver[J]. Am J Surg, 2008, 196(2):245-251.
23. Hemming AW, Mekeel K, Khanna A, et al. Portal vein resection in management of hilar cholangiocarcinoma[J]. J Am Coll Surg, 2011, 212(4):604-613.
24. Abbas S, Sandroussi C. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma[J]. HPB (Oxford), 2013, 15(7):492-503.
25. Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the "new era":the Nagoya University expe-rience[J]. J Hepatobiliary Pancreat Sci, 2010, 17(4):449-454.
26. Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma:audit of 110 patients who under-went regional and paraaortic node dissection[J]. Ann Surg, 2001, 233(3):385-392.

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Treatment and Prognostic Factor of TypeⅢHilar Cholangiocarcinoma in 170 Cases

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