Clinical Research of Hepatectomy Combined with Vascular Resection and Reconstruction in Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GUANXiao-qing , GUShu-cheng , WUJi ,  ZHENGXiang-xin , ZHANGXu-xu , YUANMu , WUJian-qiang , CHENYan , WUJi-sheng

Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical College/Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, Suqian 223800, jiangsu Province, China;

Corresponding?author：

ZHENGXiang-xin, Email: zhengxiangxin_dr@163.com

Keywords：

Hilar cholangiocarcinoma; Hepatectomy; Vascular resection; Vascular reconstruction; Radical operation

DOI：

10.7507/1007-9424.20150016

Video：

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Objective To explore the clinical significance of hepatectomy combined with vascular reconstruction in hilar cholangiocarcinoma with vascular invasion. Methods The clinical data of 62 cases of hilar cholangiocarcinoma with vascular invasion in Suqian People's Hospital of Nanjing Drum-Tower Hospital Group from January 2006 to January 2014 were analyzed retrospectively. All cases were divided into two groups according to assessment of surgical trauma tolerance, nutritional status, and family's wishes. Thirty-three cases underwent hilar cholangiocarcinoma radical operation and hepatic artery combined with portal vein resection and reconstruction (combined resection group), while 29 cases of hilar cholangiocarcinoma underwent palliative surgery for treating jaundice in synchronization (palliative operation group). Results The median survivals in combined resection group and palliative operation group was 26.3 and 9.6 months, respectively. The survival rates of 1-year, 2-year, and 3-year between combined resection group and palliative operation group were 84.85% vs. 26.32%, 66.67% vs. 15.79%, and 42.42% vs. 0, respectively, there were significant differences between both groups in survival time and survival rate (t=4.470, P=0.000; χ²=28.338, 20.348, and 15.891, P=0.000). Among of 33 cases in combined resection group, postoperative complications occurred in 9 cases, the rate of complications was 27.27% and the mortality rate in perioperative period was 3.03%; while postoperative complications in palliative operation group occurred in 5 cases, the rate of complications was 17.24%, no case died in the perioperative period. There were no significant difference between both groups in the rate of postoperative complications and the mortality rate in perioperative period (χ²=0.888, P=0.346; χ²=0.893, P=0.345). Conclusions Hepatectomy combined with vascular resection and reconstruction can significantly improve the radical resection (R0) rate of HCCA, and greatly increase the 1-year, 2-year, and 3-year survival rates of patients. Furthermore, complications can be controlled, and the mortality rate in perioperative period does not increase.

Citation： GUANXiao-qing, GUShu-cheng, WUJi, ZHENGXiang-xin, ZHANGXu-xu, YUANMu, WUJian-qiang, CHENYan, WUJi-sheng. Clinical Research of Hepatectomy Combined with Vascular Resection and Reconstruction in Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(1): 64-69. doi: 10.7507/1007-9424.20150016 Copy

1.	Jang JY, Kim SW, Park DJ, et al. Actual long-term outcome of extrahepaticbile cancer after surgical resection. Ann Surg, 2005, 241(1):77-84.
2.	Deoliveira ML, Schulick RD, Nimura A, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4):1363-1371.
3.	許戈良, 馬金良, 李建生, 等.肝門膽管癌切除的處理體會.外科理論與實踐, 2003, 8(2):118-120.
4.	莢衛東, 許戈良, 劉文斌.肝門上入路切除肝門部膽管癌的手術技巧.國際外科學雜志, 2011, 38(5):356-358.
5.	許戈良, 胡何節, 馬金良, 等.肝門上入路法切除高位膽管癌.臨床外科雜志, 2006, 14(2):90-92.
6.	杜成友, 劉強.肝門膽管癌的術式選擇.中國普外基礎與臨床雜志, 2014, 21(3):265-267.
7.	姜洪池, 孫備, 陸朝陽, 等. 54例肝門部膽管癌手術切除技術體會.中華外科雜志, 2006, 44(7):441-444.
8.	梁力建, 賴佳明, 李紹強, 等. 103例肝門部膽管癌的外科手術切除治療.中華外科雜志, 2006, 44(13):882-884.
9.	劉付寶, 耿小平, 趙紅川, 等.根治性切除治療肝門部膽管癌.肝膽外科雜志, 2011, 19(4):267-270.
10.	Stroszczynski C, Hunerbein M. Malignant biliary obstruction:value of imaging findings. Abdom Imaging, 2005, 30(3):314-323.
11.	Vladov N, Lukanova TS, Takorov I, et al. Single centre experience with surgical treatment of hilar cholangiocarcinoma. Chirurgia (Bucur), 2013, 108(3):299-303.
12.	彭沙沙, 黃漢飛, 段鍵, 等.聯合肝葉切除治療肝門部膽管癌的療效分析.中國癌癥雜志, 24(6):451-456.
13.	鄒聲泉.重視肝門部膽管癌的手術治療.中國普外基礎與臨床雜志, 2014, 21(3):257-259.
14.	孫誠誼, 江建新.肝門部膽管癌的外科治療.世界華人消化雜志, 2011, 19(8):771-776.
15.	成雨, 陳鴻強, 戴劍, 等.肝切除、肝門-空腸吻合治療BismuthⅣ肝門部膽管癌.中華普通外科雜志, 2010, 25(4):269-272.
16.	Ebata T, Nagino M, Kamiya J, et al. Hepatectomywith portal vein resection for hilar cholangiocarcinoma:audit of 52 consecutive cases. Ann Surg, 2003, 238(5):720-727.
17.	Munoz L, Roayaie S, MamanD, et al. Hilar cholangiocarcinoma involving the portal vein bifurcation:long-term results after resecton. J Hepatobiliary Pancreat Surg, 2002, 9(2):237-241.
18.	Miyazaki M, Ito H, Kmiura F, et al. Hilar cholangiocarcinoma. Nippon Geka Gakkai Zasshi, 2005, 106(4):291-296.
19.	Franco D, Usatoff V. Surgery for cholangiocarcinorna. Hepatogastroenterology, 2001, 48(37):53-55.
20.	唐文皓, 唐健雄, 袁祖榮.肝門部膽管癌的治療現狀.國際外科學雜志, 2012, 39(5):296-298.
21.	劉占兵, 楊尹默.目前膽道外科應重視的幾個問題.國際外科學雜志, 2012, 39(5):298-301.
22.	李漢賢, 唐超明, 秦春宏, 等.聯合肝葉和肝門血管切除治療肝門膽管癌.中國普通外科雜志, 2004, 13(7):485-488.
23.	韓風, 周進學, 龐春, 等.聯合肝動脈切除在肝門部膽管癌根治術中的應用.中國現代醫學雜志, 2007, 17(11):1395-1397.
24.	蔡守旺, 曾建平, 梁雨榮, 等.肝門部膽管癌根治性切除術中血管切除和重建15例報告.腹部外科, 2010, 23(2):77-79.
25.	李文崗, 李濱, 黃志強, 等.失去肝動脈血液供應后大鼠肝門部膽管周圍血管叢變化的三維構像研究.中華器官移植雜志, 2006, 27(3):149-151.
26.	曾永毅, 鄭樹國, 別平, 等.合并肝動脈切除重建的肝門部膽管癌根治術.中國實用外科雜志, 2007, 27(5):381-384.
27.	陳志國, 雷霆, 魏海梁, 等.肝門部膽管癌根治術肝動脈重建7例體會.肝膽胰外科雜志, 2010, 22(4):316-318.
28.	管小青, 陳焰, 顧書成, 等.擴大胰十二指腸切除術中聯合肝動脈、肝固有固有動脈與髂內靜脈切除重建應用的可行性研究.中國普外基礎與臨床雜志, 2012, 19(2):181-187.
29.	耿小平, 劉付寶.聯合肝葉擴大切除治療肝門膽管癌.肝膽外科雜志, 2008, 16(2):144-145.
30.	Kondo S, Hayakawa N, Nimura Y, et al. Extensive surgery for carcinoma of gallbladder. Br J Surg, 2002, 89(2):179-184.
31.	Gerhards MF, Van Gulik TM, DeW it LT, et al. Evaluation of morbidity andmortality after resection forhilar cholangiocarcinoma-a single center experience. Surgery, 2000, 127(4):395-404.
32.	De Santibafies E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure:a novel method. World J Surg, 2012, 36(1):125-128.
33.	李風, 周光文. 2 280例肝門膽管癌的薈萃分析.中華肝膽外科雜志, 2013, 19(3):171-176.

1. Jang JY, Kim SW, Park DJ, et al. Actual long-term outcome of extrahepaticbile cancer after surgical resection. Ann Surg, 2005, 241(1):77-84.
2. Deoliveira ML, Schulick RD, Nimura A, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4):1363-1371.
3. 許戈良, 馬金良, 李建生, 等.肝門膽管癌切除的處理體會.外科理論與實踐, 2003, 8(2):118-120.
4. 莢衛東, 許戈良, 劉文斌.肝門上入路切除肝門部膽管癌的手術技巧.國際外科學雜志, 2011, 38(5):356-358.
5. 許戈良, 胡何節, 馬金良, 等.肝門上入路法切除高位膽管癌.臨床外科雜志, 2006, 14(2):90-92.
6. 杜成友, 劉強.肝門膽管癌的術式選擇.中國普外基礎與臨床雜志, 2014, 21(3):265-267.
7. 姜洪池, 孫備, 陸朝陽, 等. 54例肝門部膽管癌手術切除技術體會.中華外科雜志, 2006, 44(7):441-444.
8. 梁力建, 賴佳明, 李紹強, 等. 103例肝門部膽管癌的外科手術切除治療.中華外科雜志, 2006, 44(13):882-884.
9. 劉付寶, 耿小平, 趙紅川, 等.根治性切除治療肝門部膽管癌.肝膽外科雜志, 2011, 19(4):267-270.
10. Stroszczynski C, Hunerbein M. Malignant biliary obstruction:value of imaging findings. Abdom Imaging, 2005, 30(3):314-323.
11. Vladov N, Lukanova TS, Takorov I, et al. Single centre experience with surgical treatment of hilar cholangiocarcinoma. Chirurgia (Bucur), 2013, 108(3):299-303.
12. 彭沙沙, 黃漢飛, 段鍵, 等.聯合肝葉切除治療肝門部膽管癌的療效分析.中國癌癥雜志, 24(6):451-456.
13. 鄒聲泉.重視肝門部膽管癌的手術治療.中國普外基礎與臨床雜志, 2014, 21(3):257-259.
14. 孫誠誼, 江建新.肝門部膽管癌的外科治療.世界華人消化雜志, 2011, 19(8):771-776.
15. 成雨, 陳鴻強, 戴劍, 等.肝切除、肝門-空腸吻合治療BismuthⅣ肝門部膽管癌.中華普通外科雜志, 2010, 25(4):269-272.
16. Ebata T, Nagino M, Kamiya J, et al. Hepatectomywith portal vein resection for hilar cholangiocarcinoma:audit of 52 consecutive cases. Ann Surg, 2003, 238(5):720-727.
17. Munoz L, Roayaie S, MamanD, et al. Hilar cholangiocarcinoma involving the portal vein bifurcation:long-term results after resecton. J Hepatobiliary Pancreat Surg, 2002, 9(2):237-241.
18. Miyazaki M, Ito H, Kmiura F, et al. Hilar cholangiocarcinoma. Nippon Geka Gakkai Zasshi, 2005, 106(4):291-296.
19. Franco D, Usatoff V. Surgery for cholangiocarcinorna. Hepatogastroenterology, 2001, 48(37):53-55.
20. 唐文皓, 唐健雄, 袁祖榮.肝門部膽管癌的治療現狀.國際外科學雜志, 2012, 39(5):296-298.
21. 劉占兵, 楊尹默.目前膽道外科應重視的幾個問題.國際外科學雜志, 2012, 39(5):298-301.
22. 李漢賢, 唐超明, 秦春宏, 等.聯合肝葉和肝門血管切除治療肝門膽管癌.中國普通外科雜志, 2004, 13(7):485-488.
23. 韓風, 周進學, 龐春, 等.聯合肝動脈切除在肝門部膽管癌根治術中的應用.中國現代醫學雜志, 2007, 17(11):1395-1397.
24. 蔡守旺, 曾建平, 梁雨榮, 等.肝門部膽管癌根治性切除術中血管切除和重建15例報告.腹部外科, 2010, 23(2):77-79.
25. 李文崗, 李濱, 黃志強, 等.失去肝動脈血液供應后大鼠肝門部膽管周圍血管叢變化的三維構像研究.中華器官移植雜志, 2006, 27(3):149-151.
26. 曾永毅, 鄭樹國, 別平, 等.合并肝動脈切除重建的肝門部膽管癌根治術.中國實用外科雜志, 2007, 27(5):381-384.
27. 陳志國, 雷霆, 魏海梁, 等.肝門部膽管癌根治術肝動脈重建7例體會.肝膽胰外科雜志, 2010, 22(4):316-318.
28. 管小青, 陳焰, 顧書成, 等.擴大胰十二指腸切除術中聯合肝動脈、肝固有固有動脈與髂內靜脈切除重建應用的可行性研究.中國普外基礎與臨床雜志, 2012, 19(2):181-187.
29. 耿小平, 劉付寶.聯合肝葉擴大切除治療肝門膽管癌.肝膽外科雜志, 2008, 16(2):144-145.
30. Kondo S, Hayakawa N, Nimura Y, et al. Extensive surgery for carcinoma of gallbladder. Br J Surg, 2002, 89(2):179-184.
31. Gerhards MF, Van Gulik TM, DeW it LT, et al. Evaluation of morbidity andmortality after resection forhilar cholangiocarcinoma-a single center experience. Surgery, 2000, 127(4):395-404.
32. De Santibafies E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure:a novel method. World J Surg, 2012, 36(1):125-128.
33. 李風, 周光文. 2 280例肝門膽管癌的薈萃分析.中華肝膽外科雜志, 2013, 19(3):171-176.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Research of Hepatectomy Combined with Vascular Resection and Reconstruction in Hilar Cholangiocarcinoma

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