Major hepatectomy in Bismuth types I and II hilar cholangiocarcinoma

Historically, hilar bile duct resection (HBDR) has been regarded as the choice of treatment for Bismuth types I and II hilar cholangiocarcinoma (HCCA). The present study aimed to evaluate the advantages of major liver resection (MLR) in the treatment of patients with Bismuth types I and II HCCA when...

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Published in:The Journal of surgical research Vol. 194; no. 1; pp. 194 - 201
Main Authors: Xiong, Junjie, Nunes, Quentin M., Huang, Wei, Wei, Ailin, Ke, Nengwen, Mai, Gang, Liu, Xubao, Hu, Weiming
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.03.2015
Subjects:
Aged
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - pathology
Bile Duct Neoplasms - surgery
Bile Ducts, Intrahepatic
Bismuth classification
Cholangiocarcinoma - mortality
Cholangiocarcinoma - pathology
Cholangiocarcinoma - surgery
Female
Hepatectomy
Hilar bile duct resection
Hilar cholangiocarcinoma
Humans
Length of Stay
Major liver resection
Male
Middle Aged
Neoplasm Recurrence, Local
Surgery
Survival Rate
Hilar bile duct resection
Bismuth classification
Major liver resection
Hilar cholangiocarcinoma
ISSN:0022-4804, 1095-8673, 1095-8673
Online Access:Get full text
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Summary:Historically, hilar bile duct resection (HBDR) has been regarded as the choice of treatment for Bismuth types I and II hilar cholangiocarcinoma (HCCA). The present study aimed to evaluate the advantages of major liver resection (MLR) in the treatment of patients with Bismuth types I and II HCCA when compared with HBDR. Between January 2005 and September 2012, in total, 52 patients with Bismuth types I and II HCCA who underwent HBDR alone or MLR were included for retrospective analysis. The intraoperative outcomes, postoperative complications, and oncological outcomes including recurrence and overall or disease-free survival rate were compared. The MLR group had significantly higher curative resection rates compared with the HBDR group (95% versus 62.5%, P = 0.021) and lower tumor recurrence (28% versus 63%, P = 0.049), albeit with longer operating time (395.5 ± 112.7 versus 270.9 ± 98.8, P < 0.001), and higher blood transfusion requirements (70% versus 16%, P < 0.001). MLR resulted in significantly higher overall postoperative morbidity (70% versus 34.4%, P = 0.012), compared with HBDR alone. When restricted to R0 resections for all the procedures, MLR significantly increased the overall postoperative survival rate compared with the HBDR group (P = 0.016); the overall survival rate at 1, 3 y was 68.4% and 60.8% for MLR group and 59.6% and 21.9% for HBDR group, respectively. Also, the disease-free survival rate was significantly higher in patients who underwent MLR, as compared with those who underwent HBDR (53.2% versus 0% at 3 y, P = 0.005). Our study has shown that MLR results in higher curative resections, fewer recurrences, and increased postoperative survival rate for Bismuth types I and II HCCA as compared with HBDR alone. However, there is a need for well-designed, multicenter studies to be undertaken to better inform a decision on the standard treatment for Bismuth types I and II HCCA.
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ISSN:0022-4804
1095-8673
1095-8673
DOI:10.1016/j.jss.2014.10.029