Combined vascular resection and reconstruction for advanced hilar cholangiocarcinoma
نویسندگان
چکیده
Background: Hilar cholangiocarcinoma with vascular invasion was previously regarded as locally advanced disease and a contraindication to curative resection. The significance of combined vascular resection and reconstruction has remained ambiguous and controversial. This study aimed to reveal the role and efficacy of concomitant vascular resection and reconstruction on survival of patients with hilar cholangiocarcinoma. Materials and Methods: From January 2006 to December 2014, totally 19 out of 95 hilar cholangiocarcinoma patients undergoing curative resection were performed with combined vascular resection and reconstruction in a single institute including right hepatic artery alone (n=6), portal vein plus right hepatic artery (n=3) and portal vein alone (n=10), the remaining 67 patients underwent without vascular resection. The clinicopathologic features and survival outcomes of candidates were analyzed retrospectively. Results: The one, three and five-years survival rates in vascular reconstruction group were 78.8%, 21.3%, 0% respectively, comparing with that of non-vascular resection group 79.3%, 31.8%, 12.3% respectively (P=0.416). Median survival time in vascular reconstruction group was 17 months with mortality of 5.26% (1/19), which was close to that of non-vascular resection group. Pathological examination confirmed 36.84% patients (7/19) were with microscopic invasion. Multivariate analysis showed that CA-199 above 200 U/ml (P=0.035) and pathological differentiation (P=0.015) were independent prognostic factors of adverse effect on postoperative survival. Conclusion: Combined vascular resection and reconstruction for advanced hilar cholangiocarcinoma could improve survival with acceptable efficacy and safety in selected patients.
منابع مشابه
Right hepatectomy for a detoured left hepatic artery in hilar cholangiocarcinoma—report of a rare but rational resection
BACKGROUND Curative hepatectomy with bile duct resection is the treatment for perihilar cholangiocarcinoma. A locally advanced tumor necessitates hepatectomy with simultaneous vascular resection, and reconstruction remains an obstacle for surgeons. Studies have focused on the variations of hepatic arteries. Nevertheless, the anatomical alignment of the portal veins, bile ducts, and hepatic arte...
متن کاملSurgical management of hilar cholangiocarcinoma.
OBJECTIVE To assess the surgical management of hilar cholangiocarcinoma over a time period when liver resection was considered standard management. SUMMARY BACKGROUND DATA Hilar cholangiocarcinoma remains a difficult challenge for surgeons. An advance in surgical treatment is the addition of liver resection to the procedure. However, liver resection in the setting of liver dysfunction caused ...
متن کاملLaparoscopic resection of hilar cholangiocarcinoma.
BACKGROUND Surgical resection is the only curative treatment for hilar cholangiocarcinoma. Laparoscopic hepatectomy has been used to treat several types of liver neoplasms. However, technical issues have limited the adoption of laparoscopy for the treatment of hilar cholangiocarcinoma. To date there is only one report of minimally invasive procedure for hilar cholangiocarcinoma in the literatur...
متن کاملProximal biliary malignancy.
Hilar cholangiocarcinoma is a rare malignancy that occurs at the bifurcation of the bile ducts. Complete surgical excision with negative histologic margins remains the only hope for cure or long-term survival. Because of its location and proximity to the vascular inflow of the liver, surgical resection is technically difficult and may require advanced vascular reconstructions to achieve complet...
متن کاملHepatic artery reconstruction first for the treatment of hilar cholangiocarcinoma bismuth type IIIB with contralateral arterial invasion: a novel technical strategy.
BACKGROUND En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic ar...
متن کامل