Changes in the surgical approach to hilar cholangiocarcinoma during an 18‐year period in a Western single center

Journal of Hepato-Biliary-Pancreatic Sciences - Tập 17 Số 3 - Trang 329-337 - 2010
Giorgio Ercolani1, Matteo Zanello1, Gian Luca Grazi1, Matteo Cescon1, Matteo Ravaioli1, Massimo Del Gaudio1, Gaetano Vetrone1, Alessandro Cucchetti1, Giovanni Brandi2, Giovanni Ramacciato1, Antonio Daniele Pinna1
1Department of Surgery and Transplantation, Hospital Sant'Orsola‐Malpighi University of Bologna Via Massarenti 9 40138 Bologna Italy
2Department of Oncology, S. Orsola Hospital University of Bologna Bologna Italy

Tóm tắt

AbstractBackgroundLiver resection is the only potential curative treatment for hilar cholangiocarcinoma. In this article, we evaluate mortality, survival, prognostic factors, and changes in surgical approach during the last two decades at a Western hepato‐biliary center.MethodsFifty‐one patients undergoing liver resections constitute the study population. Patients undergoing palliative procedures were considered as a control group for comparison to the resected group. After 1997, a more aggressive surgical approach was applied that is based on the experience of Japanese surgeons.ResultsCurative resections were achieved in 37 (72.5%) patients, and R1 resections were performed in 14 (27.5%). The overall 3‐ and 5‐year survival rates were 47.3 and 34.1%, respectively. The 3‐ and 5‐year survival rates were 38 and 19% in the R1 resection group, and 15% and 0 in the non‐resected group, respectively. Univariate analysis revealed that lymph node and perineural invasion, R1 resection, and a bilirubin level >10 mg/dl affected long‐term survival. Multivariate analysis showed that only perineural invasion was significant in affecting long‐term survival. Univariate analysis showed that the mean preoperative bilirubin levels and mean blood transfusion were related to the mortality rate. The resectability rate significantly increased from 25 to 75.6% after 1997 following implementation of the new surgical approach.ConclusionsAn aggressive surgical approach increases the resectability rate and may improve long‐term survival even after R1 resection. Severe hyperbilirubinemia should be preoperatively drained, possibly by the percutaneous approach.

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Tài liệu tham khảo

10.1053/jhep.2003.50200

10.1016/0002-9343(65)90178-6

10.1016/S0959-8049(97)10166-6

10.1007/s005340050170

10.1111/j.1365-2036.2006.02900.x

Patel T, 2006, Cholangiocarcinoma, Gastroenterol Hepatol., 3, 33

10.1097/00000658-199912000-00010

10.1097/01.sla.0000094437.68038.a3

10.1007/s00534-004-0912-9

10.1001/archsurg.139.5.514

10.1016/j.ejso.2005.02.021

10.1097/01.sla.0000160817.94472.fd

10.1148/radiol.2383050419

10.1097/00000658-200008000-00003

10.1245/ASO.2006.05.053

10.1002/bjs.5482

10.1016/S1365-182X(17)30755-4

Bismuth H, 1975, Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver, Surg Gynecol Obstet., 140, 170

10.1136/gut.51.suppl_6.vi1

10.1046/j.1365-2168.2000.01532.x

10.1097/00000658-200110000-00010

10.1016/j.ejso.2007.10.005

10.1007/s00423-003-0383-5

10.1097/01.sla.0000160701.38945.82

10.1097/01.sla.0000217639.10331.47

10.1007/s005340050169

10.1007/s005340050167

10.1097/01.SLA.0000074984.83031.02

10.1097/01.SLA.0000074960.55004.72

10.1097/01.sla.0000129491.43855.6b

10.1097/01.sla.0000217605.66519.38

10.1016/j.surg.2006.09.016

10.1016/j.amjsurg.2007.07.033

10.1002/bjs.5783

10.1007/BF01658686

10.1097/00000658-199911000-00008

10.1097/00000658-200103000-00013

Poon RT, 2004, Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary disease: analysis of 1222 consecutive patients from a prospective disease, Ann Surg., 240, 698, 10.1097/01.sla.0000141195.66155.0c

10.1001/archsurg.143.4.380

10.1046/j.0007-1323.2001.01782.x

10.1001/archsurg.135.3.302

10.1001/archsurg.134.3.261

10.1097/00000658-200207000-00005

Zhang BH, 2006, Surgical therapy for hilar cholangiocarcinoma: analysis of 198 cases, Hepatobiliary Pancreat Dis Int., 5, 278

10.1097/SLA.0b013e3181492795

10.1001/archsurg.133.3.293

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Journal of Hepato-Biliary-Pancreatic Sciences

Tập 17 Số 3

329-337

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