Surgical treatment of perihilar cholangiocarcinoma with the portal vein invasion

Keywords: perihilar cholangiocarcinoma; portal vein; surgical treatment

Abstract

Introduction. Surgical method constitutes the only one for radical treatment of perihilar cholangiocarcinoma, permitting to improve late follow-up results and the patients’ survival indices. Tumoral invasion into portal vein constitutes a peculiar complexity.

Objective. Studying of results of surgical treatment in patients, suffering perihilar cholangiocarcinoma with the portal vein (PV) invasion.

Маterials and methods. From 2003 to 2017 yr in the Clinic a vast and extended hepatic resection for perihilar cholangiocarcinoma was performed in153 patients.

Results. Anatomic classification of perihilar cholangiocarcinoma by Bismuth-Corlette was applied for estimation of the biliary tree affection. In 66 (43%) of patients hepatic resection was added by the PV resection with its subsequent reconstruction. The 1, 3- and 5-year survival indices after performance of the PV resection have constituted 81.8, 40.9 and 31.8% accordingly.

Conclusion. Аgressive tactics of surgical treatment of perihilar cholangiocarcinoma guarantees maximal radicalism, help to increase resectability in tumoral invasion into PV with affordable lethality and late survival indices.

Author Biographies

О. G. Коtenko, Shalimov National Institute of Surgery and Transplantology, Kyiv

Oleg Kotenko, PhD,
Head of the Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
kog1999@gmail.com

А. О. Popov, Shalimov National Institute of Surgery and Transplantology, Kyiv

Oleksii Popov - transplant surgeon, researcher
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
popovalexey@gmail.com

А. V. Grinenko, Shalimov National Institute of Surgery and Transplantology, Kyiv

Oleksandr Hrynenko - transplant surgeon, researcher
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
grinenkoalex@gmail.com

А. V. Gusev, Shalimov National Institute of Surgery and Transplantology, Kyiv

Andrii Gusev - PhD, Senior Researcher,
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
portalschik74@mail.ru

М. S. Grigoryan, Shalimov National Institute of Surgery and Transplantology, Kyiv

Marat Grygorian - transplant surgeon
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
grigmarat78@gmail.com

D. А. Fedorov, Shalimov National Institute of Surgery and Transplantology, Kyiv

Denis Fedorov - PhD, Senior Researcher,
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
D.a.fedorov@gmail.com

А. А. Коrshak, Shalimov National Institute of Surgery and Transplantology, Kyiv

Oleksandr Korshak transplant surgeon
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
akorshak@ukr.net

А. N. Оstapishen, Shalimov National Institute of Surgery and Transplantology, Kyiv

Oleksandr Ostapishen transplant surgeon
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
o.ostapyshen@gmail.como.ostapyshen@gmail.com

А. А. Мinich, Shalimov National Institute of Surgery and Transplantology, Kyiv

Artem Minich - transplant surgeon, PhD researcher
Department of Transplantation and Surgery of the Liver,
A.A.Shalimov National Institute of Surgery and Transplantology;
30, Heroiv Sevastopolya str.,Kyiv, Ukraine, 03680
+38(044) 4971374,
artminich@gmail.com

References

1. Van Gulik TM, Dinant S, Busch OR, Rauws EA, Obertop H, Gouma DJ. Original article: New surgical approaches to the Klatskin tumour. Aliment Pharmacol Ther. 2007;26 Suppl 2:127-32. doi: 10.1111/j.1365-2036.2007.03485.x.

2. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140(2):170-8. PMID: 1079096

3. Wu XS, Dong P, Gu J, Li ML, Wu WG, Lu JH, et al. Combined portal vein resection for hilar cholangiocarcinoma: a meta-analysis of comparative studies. J Gastrointest Surg. 2013;17(6):1107-15. doi: 10.1007/s11605-013-2202-9. Epub 2013 Apr 17.

4. Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ. Surgical management of hilar cholangiocarcinoma. Ann Surg. 2005;241(5):693-9; discussion 699-702. PMID: 15849505

5. Hemming AW, Reed AI, Howard RJ, Fujita S, Hochwald SN, Caridi JG, et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg. 2003;237(5):686-91; discussion 691-3. doi: 10.1097/01.SLA.0000065265.16728.C0.

6. Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7(2):155-62. DOI: 10.1007/s005340000070155.534. PMID: 10982608.

7. Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Shimizu Y, et al. Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? Surgery. 1998;123(2):131-6. PMID: 9481397.

8. Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience. HPB (Oxford). 2005;7(4):259-62. doi: 10.1080/13651820500373010.

9. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230(6):808-18; discussion 819. PMID: 10615936.

10. Neuhaus P, Jonas S, Settmacher U, Thelen A, Benckert C, Lopez-Hanninen E, et al. Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbecks Arch Surg. 2003;388(3):194-200. doi: 10.1111/j.1477-2574.2012.00616.x

11. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunven P, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107(5):521-7. PMID: 2333592.

12. Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238(5):720-7. doi: 10.1097/01.sla.0000094437.68038.a3
Published
2018-01-28
Section
General Problems of Surgery

Most read articles by the same author(s)