Víctor Molina1, Jaime Sampson2, Joana Ferrer2, Alba Díaz3, Juan Ramon Ayuso4, Santiago Sánchez-Cabús2, Josep Fuster2, Juan Carlos García-Valdecasas2. 1. HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain. bistums@hotmail.com. 2. HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain. 3. Department of Pathology, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain. 4. Department of Radiology, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.
Abstract
OBJECTIVE: The objective of this study was to analyse the safety, feasibility and survival outcomes of our treatment of perihilar cholangiocarcinoma (PHC) since the introduction of more aggressive approaches (en bloc, vascular and extended liver resections) in 2007. PATIENTS AND METHODS: From July 2007 to December 2014, 32 consecutive patients with PHC underwent surgery with curative intent. Surgery with resection and reconstruction of the portal vein bifurcation and right hepatic artery was performed if necessary for a complete removal of the tumour. Perioperative data and postoperative histological findings, tumour recurrence rates and survival rates were recorded. Seventeen (53%) of the patients presented with stage IIIb or IV according to the UICC classification system. RESULTS: The 5-year survival rate in our series was 45%, and this percentage increased to 65% when patients with advanced stage cancer (stage IIIb or higher) were excluded. We performed 3 arterials and 23 portal vein reconstruction. Twelve patients underwent extended hemihepatectomy. We achieved cancer-free margins in 19 patients (60%). Tumour stage and nodal involvement were the most important prognostic factors. The perioperative morbidity and mortality rates of this cohort were 72% (23) and 15.6% (5), respectively; these results were similar to data published by other groups. CONCLUSIONS: An aggressive approach involving en bloc or extended liver resection combined with vascular reconstruction provides acceptable morbidity and mortality and increases the 5-year survival rate of PHC.
OBJECTIVE: The objective of this study was to analyse the safety, feasibility and survival outcomes of our treatment of perihilar cholangiocarcinoma (PHC) since the introduction of more aggressive approaches (en bloc, vascular and extended liver resections) in 2007. PATIENTS AND METHODS: From July 2007 to December 2014, 32 consecutive patients with PHC underwent surgery with curative intent. Surgery with resection and reconstruction of the portal vein bifurcation and right hepatic artery was performed if necessary for a complete removal of the tumour. Perioperative data and postoperative histological findings, tumour recurrence rates and survival rates were recorded. Seventeen (53%) of the patients presented with stage IIIb or IV according to the UICC classification system. RESULTS: The 5-year survival rate in our series was 45%, and this percentage increased to 65% when patients with advanced stage cancer (stage IIIb or higher) were excluded. We performed 3 arterials and 23 portal vein reconstruction. Twelve patients underwent extended hemihepatectomy. We achieved cancer-free margins in 19 patients (60%). Tumour stage and nodal involvement were the most important prognostic factors. The perioperative morbidity and mortality rates of this cohort were 72% (23) and 15.6% (5), respectively; these results were similar to data published by other groups. CONCLUSIONS: An aggressive approach involving en bloc or extended liver resection combined with vascular reconstruction provides acceptable morbidity and mortality and increases the 5-year survival rate of PHC.
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