Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

• DOI: 10.1007/s005340050170
• Publication Date: 2003-02-13T01:54:09Z
• Authors: Yuji Nimura; Junichi Kamiya; Satoshi Kondo; Masato Nagino; Katsuhiko Uesaka; Koji Oda; Tsuyoshi Sano; Hideo Yamamoto; Naokazu Hayakawa
• Keywords: Adult; Male; Portal Vein; Middle Aged; Prognosis; Combined Modality Therapy; Embolization, Therapeutic; 3. Good health; Cholangiocarcinoma; Survival Rate; 03 medical and health sciences; Bile Ducts, Intrahepatic; Treatment Outcome; 0302 clinical medicine; Bile Duct Neoplasms; Japan; Preoperative Care; Drainage; Hepatectomy; Humans; Female; Aged; Retrospective Studies

From 1977 to 1997, surgical resection was possible in 142 (80%) of 177 patients with hilar cholangiocarcinoma after relieving jaundice by single or multiple percutaneous transhepatic biliary drainage followed by percutaneous transhepatic cholangioscopy and/or percutaneous trans-hepatic portal vein embolization. Curative resection was possible in 108 (61%) of the 142 patients, and 100 of these patients underwent various types of hepatectomy with caudate lobectomy for a 30-day operative mortality rate of 6% and 9% hospital mortality. Combined portal vein resection was carried out in 43 cases including 41 hepatectomies and 2 bile duct resections. Hepatopancreatoduodenectomy was performed in 16 patients. Cancer recurrence was observed in 58 of the 108 patients undergoing curative resection. The 3-, 5-, and 10-year survival rates for 100 patients undergoing curative hepatectomy and 8 with curative bile duct resection were 43%, 26%, and 19%; and 31%, 16%, and 0%, respectively; those for 40 patients with positive lymph node metastasis, 84 with perineural invasion, and 43 with combined portal vein resection were 27%, 14%, and 7%; 34%, 21%, and 13%; and 18%, 6%, and 0%, respectively. These survival rates are significantly better than those for 35 patients with unresectable cancer. Curative resection after aggressive preoperative management is recommended as a reasonable surgical approach to hilar cholangiocarcinoma.