Experience of Surgical Treatment for Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CUIYun-fu , XUYi

Department of Biliary and Pancreatic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China;

Corresponding?author：

CUIYun-fu, Email: yfcui777@hotmail.com

Keywords：

Hilar cholangiocarcinoma; Surgical treatment; Percutaneous transhepatic cholangial drainage; Total caudate lobe resection

DOI：

10.7507/1007-9424.20160337

Video：

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Objective To summarize experience of surgical treatment for hilar cholangiocarcinoma. Methods From January 2009 to July 2011, 87 patients with hilar cholangiocarcinoma were enrolled into the department of Biliary and Pancreatic Surgery of the Second Affiliated Hospital of Harbin Medical University. The intra-and post-operative results were analyzed. Results Out of 87 cases, the resection rate was 67.8% (59/87). The radical (R0) resection rate was 48.3% (42/87), R1 resection rate was 11.5% (10/87), palliative (R2) resection rate was 8.0% (7/87). The patients were successfully got through the perioperative period, threre was no operative mortality. 1-year, 3-year, 5-year survival rates of the R0 resection group were 92.9% (39/42), 31.0% (13/42), 19.0% (8/42), respectively. No patient was alive more than 3 years in the groups of R2 resection and internal or external drainage. 1-year and 2-year survival rates of the R1 resection group were 70.0% (7/10) and 20.0% (2/10), respectively. 1-year survival rate of the R2 resection group was 57.1% (4/7). 1-year survival rate of the internal or external drainage group was 35.7% (10/28). 1-year, 3-year, and 5-year survival rates of the R1 resection group and R2 resection group were significantly lower than those of the R0 resection group (P<0.05). Conclusion For hilar cholangiocarcinoma, radical resection is the only method to cure. Preoperative evaluation, percutaneous transhepatic cholangial drainage so as to relieve obstruction of biliary tract, proper liver resection and intraoperative pathology for resection margin are imperative guarantees lead to radical resection. Palliative resection might prolong survival time and improve quality of life.

Citation： CUIYun-fu, XUYi. Experience of Surgical Treatment for Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1311-1314. doi: 10.7507/1007-9424.20160337 Copy

1.	Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med, 1965, 38:241-256.
2.	Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology, 2013, 145(6):1215-1229.
3.	孫學軍, 鄭見寶, 賀賽. 肝門部膽管癌的外科治療及預后影響因素分析. 中國普外基礎與臨床雜志, 2014, 21(3):273-277.
4.	Zhimin G, Noor H, Jian-Bo Z, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma-a review. Med Sci Monit, 2013, 19:648-656.
5.	Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, et al. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol, 2013, 5(7):132-138.
6.	Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol, 2013, 28(4):593-607.
7.	石力, 湯禮軍, 汪濤, 等. 膽道金屬支架置入治療肝門部膽管癌的臨床研究. 中國普通外科雜志, 2012, 21(8):918-921.
8.	楊屹, 紀宗正, 吳濤, 等. PTCD 在肝門部膽管癌治療中的臨床作用(附67例報道). 中國普外基礎與臨床雜志, 2014, 21(3):285-288.
9.	Kawakubo K, Kawakami H, Kuwatani M, et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholan-giocarcinoma. World J Gastrointest Endosc, 2016, 8(9):385-390.
10.	劉訓強, 陳宦君, 王家平, 等. PTCD治療阻塞性黃疸438例的臨床療效觀察. 昆明醫科大學學報, 2014, 35(6):51-54.
11.	徐川, 施海彬, 劉圣, 等. 肝門部膽管癌致梗阻性黃疸介入引流治療的預后分析. 介入放射學雜志, 2012, 21(9):752-755.
12.	Hong JC, Jones CM, Duffy JP, et al. Comparative analysis of resec-tion and liver transplantation for intrahepatic and hilar cholangiocar-cinoma:a 24-year experience in a single center. Arch Surg, 2011, 146 (6):683-689.
13.	Groeschl RT, Nagorney DM. Portal vein reconstruction during surgery for cholangiocarcinoma. Curr Opin Gastroenterol, 2016, 32 (3):216-224.
14.	Schmelzle M, Sucher R, Seehofer D, et al. Regarding:impact of portal vein resection on oncologic long-term outcome in patients with hilar cholangiocarcinoma. Surgery, 2016, 159(3):986-987.
15.	Mantel HT, Westerkamp AC, Adam R, et al. Strict selection alone of patients undergoing liver transplantation for hilar cholangiocar-cinoma is associated with improved survival. PLoS One, 2016, 11(6):e0156127.
16.	van Gulik TM, Ruys AT, Busch OR, et al. Extent of liver resection for hilar cholangiocarcinoma (Klatskin tumor):how much is enough? Dig Surg, 2011, 28(2):141-147.
17.	王春, 陳哲宇, 曾勇, 等. Ⅳ型肝門部膽管癌的治療體會. 中國普外基礎與臨床雜志, 2012, 19(1):62-65.
18.	董家鴻, 項燦宏. 肝門部膽管癌的精準外科手術治療. 中華消化外科雜志, 2013, 12(3):170-173.
19.	Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma:a histologic analysis of 62 resected cases. Ann Surg, 1998, 227(3):405-411.
20.	Ercolani G, Zanello M, Grazi GL, et al. Changes in the surgical appr-oach to hilar cholangiocarcinoma during an 18-year period in a Wes-tern single center. J Hepatobiliary Pancreat Sci, 2010, 17(3):329-337.
21.	Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg, 1990, 14(4):535-543.
22.	Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilarcholan-giocarcinoma in the "new era":the Nagoya University experience. J Hepatobiliary Pancreat Sci, 2010, 17(4):449-454.
23.	姜小清, 易濱, 羅祥基, 等. 肝門部膽管癌10年外科治療經驗.中華消化外科雜志, 2010, 9(3):180-182.
24.	Abd ElWahab M, El Nakeeb A, El Hanafy E, et al. Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma:A retrospective study of 5-year survivors. World J Gastrointest Surg, 2016, 8(6):436-443.
25.	Juntermanns B, Fingas CD, Sotiropoulos GC, et al. Klatskin tumor:long-term survival following surgery. Chirurg, 2016, 87(6):514-519.

1. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med, 1965, 38:241-256.
2. Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology, 2013, 145(6):1215-1229.
3. 孫學軍, 鄭見寶, 賀賽. 肝門部膽管癌的外科治療及預后影響因素分析. 中國普外基礎與臨床雜志, 2014, 21(3):273-277.
4. Zhimin G, Noor H, Jian-Bo Z, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma-a review. Med Sci Monit, 2013, 19:648-656.
5. Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, et al. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol, 2013, 5(7):132-138.
6. Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol, 2013, 28(4):593-607.
7. 石力, 湯禮軍, 汪濤, 等. 膽道金屬支架置入治療肝門部膽管癌的臨床研究. 中國普通外科雜志, 2012, 21(8):918-921.
8. 楊屹, 紀宗正, 吳濤, 等. PTCD 在肝門部膽管癌治療中的臨床作用(附67例報道). 中國普外基礎與臨床雜志, 2014, 21(3):285-288.
9. Kawakubo K, Kawakami H, Kuwatani M, et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholan-giocarcinoma. World J Gastrointest Endosc, 2016, 8(9):385-390.
10. 劉訓強, 陳宦君, 王家平, 等. PTCD治療阻塞性黃疸438例的臨床療效觀察. 昆明醫科大學學報, 2014, 35(6):51-54.
11. 徐川, 施海彬, 劉圣, 等. 肝門部膽管癌致梗阻性黃疸介入引流治療的預后分析. 介入放射學雜志, 2012, 21(9):752-755.
12. Hong JC, Jones CM, Duffy JP, et al. Comparative analysis of resec-tion and liver transplantation for intrahepatic and hilar cholangiocar-cinoma:a 24-year experience in a single center. Arch Surg, 2011, 146 (6):683-689.
13. Groeschl RT, Nagorney DM. Portal vein reconstruction during surgery for cholangiocarcinoma. Curr Opin Gastroenterol, 2016, 32 (3):216-224.
14. Schmelzle M, Sucher R, Seehofer D, et al. Regarding:impact of portal vein resection on oncologic long-term outcome in patients with hilar cholangiocarcinoma. Surgery, 2016, 159(3):986-987.
15. Mantel HT, Westerkamp AC, Adam R, et al. Strict selection alone of patients undergoing liver transplantation for hilar cholangiocar-cinoma is associated with improved survival. PLoS One, 2016, 11(6):e0156127.
16. van Gulik TM, Ruys AT, Busch OR, et al. Extent of liver resection for hilar cholangiocarcinoma (Klatskin tumor):how much is enough? Dig Surg, 2011, 28(2):141-147.
17. 王春, 陳哲宇, 曾勇, 等. Ⅳ型肝門部膽管癌的治療體會. 中國普外基礎與臨床雜志, 2012, 19(1):62-65.
18. 董家鴻, 項燦宏. 肝門部膽管癌的精準外科手術治療. 中華消化外科雜志, 2013, 12(3):170-173.
19. Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma:a histologic analysis of 62 resected cases. Ann Surg, 1998, 227(3):405-411.
20. Ercolani G, Zanello M, Grazi GL, et al. Changes in the surgical appr-oach to hilar cholangiocarcinoma during an 18-year period in a Wes-tern single center. J Hepatobiliary Pancreat Sci, 2010, 17(3):329-337.
21. Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg, 1990, 14(4):535-543.
22. Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilarcholan-giocarcinoma in the "new era":the Nagoya University experience. J Hepatobiliary Pancreat Sci, 2010, 17(4):449-454.
23. 姜小清, 易濱, 羅祥基, 等. 肝門部膽管癌10年外科治療經驗.中華消化外科雜志, 2010, 9(3):180-182.
24. Abd ElWahab M, El Nakeeb A, El Hanafy E, et al. Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma:A retrospective study of 5-year survivors. World J Gastrointest Surg, 2016, 8(6):436-443.
25. Juntermanns B, Fingas CD, Sotiropoulos GC, et al. Klatskin tumor:long-term survival following surgery. Chirurg, 2016, 87(6):514-519.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of Surgical Treatment for Hilar Cholangiocarcinoma

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