Combined vascular resection and reconstruction for advanced hilar cholangiocarcinoma

نویسندگان

  • Zhimin Yu
  • Qing Sun
  • Yue Zhu
  • Jie Wang
  • Junyao Xu
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.

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تاریخ انتشار 2017