Surgical treatment of peripheral hepatic cholangiocarcinoma with a visceral vein invasion
Objective. To estimate the immediate and late results of surgical treatment in patients, suffering peripheral cholangiocarcinoma with invasion of visceral vein.
Маterials and methods. Retrospective analysis was accomplished for surgical treatment of 84 patients, suffering peripheral cholangiocarcinoma, in whom radical operations were performed in Department of Transplantation and Hepatic Surgery of Shalimov National Istitute of Surgery and Transplantology in a period from Jan. 2004 tо Dec. 2018 yrs. The investigated group consisted of 28 patients, to whom hepatic resection with simultant resection and plasty of visceral veins for tumoral vascular invasion was performed. Into comparison group 56 patients were included, in whom hepatic resection was not accompanied with vascular resection.
Results. Trustworthy differences were absent between groups in accordance to following indices: the patients’ age (p=0.16-0.7), gender (p=0.3), physical status (p=0.36), pre- and postoperative stationary stay (p=0.4). In the investigated group there were performed 14.3% hemihepatectomies, 32.1% extended hemihepatectomies and 53.6% threesectioectomies, and in a comparative one - 57.2% (р ≤ 0.001), 14.3% (р = 0.054) and 21.4% (р = 0.002), accordingly. Simultant intervention on biliary ducts was done in 37.5% patients from investigated group and in 25% patients from comparative group (р = 0.305), the adjacent organs resection - in 14.3 and 12.5% (р = 0.819) patients, accordingly. Clinically significant postoperative complications were observed in 25 and 30.4% (р = 0.262) patients, accordingly. In the investigated group postoperative mortality was absent, while in a comparative one it constituted 3.5%. In the investigated group a 3-years and a 5-years total survival was noted in 47 and 35% patients, accordingly, while in a comparison group - in 49% (р = 0.317) and 38% (р = 0.003) patients, accordingly. In investigated group a 3-years and a 5-years survival without a recurrence was noted in 39 and 28% patients, accordingly, and in a comparative group - in 44% (р = 0.04) and 31% (р=0.002) patients, accordingly.
Conclusion. Іnvasion of peripheral cholangiocarcinoma into visceral veins does not constitute a contraindication for operative treatment, if it is conducted in a highly specialized multidisciplinary centre.
Bergquist A, von Seth E. Epidemiology of cholangiocarcinoma. Best Pract Res Clin Gastroenterol. 2015 Apr;29(2):221-32. doi: 10.1016/j.bpg.2015.02.003. Epub 2015 Feb 16. PMID: 25966423.
Miyazaki M, Ohtsuka M, Miyakawa S, Nagino M, Yamamoto M, Kokudo N, et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition. J Hepatobiliary Pancreat Sci. 2015 Mar;22(3):181-96. doi: 10.1002/jhbp.211. Epub 2015 Feb 17. PMID: 25691463.
Bagante F, Spolverato G, Weiss M, Alexandrescu S, Marques HP, Aldrighetti L, et al. Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. J Gastrointest Surg. 2017 Nov;21(11):1888-1897. doi: 10.1007/s11605-017-3550-7. Epub 2017 Aug 24. PMID: 28840497.
Brown KM, Parmar AD, Geller DA. Intrahepatic cholangiocarcinoma. Surg Oncol Clin N Am. 2014 Apr;23(2):231-46. doi: 10.1016/j.soc.2013.10.004. PMID: 24560108; PMCID: PMC4007210.
Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology. 2013 Dec;145(6):1215-29. doi: 10.1053/j.gastro.2013.10.013. Epub 2013 Oct 15. PMID: 24140396; PMCID: PMC3862291.
Chinchilla-López P, Aguilar-Olivos NE, García-Gómez J, Hernández-Alejandro KK, Chablé-Montero F, Motola-Kuba D, et al. Prevalence, Risk Factors, and Survival of Patients with Intrahepatic Cholangiocarcinoma. Ann Hepatol. 2017 Jul-Aug;16(4):565-8. doi: 10.5604/01.3001.0010.0293. PMID: 28611259.
Dodson RM, Weiss MJ, Cosgrove D, Herman JM, Kamel I, Anders R, et al. Intrahepatic cholangiocarcinoma: management options and emerging therapies. J Am Coll Surg. 2013 Oct;217(4):736-50.e4. doi: 10.1016/j.jamcollsurg.2013.05.021. Epub 2013 Jul 24. PMID: 23890842.
Ma CH, Hwang DW, Song KB, Kim SC, Shin SH, Lee JH. Prognostic factors predicting survival rate over 10 years of patients with intrahepatic cholangiocarcinoma after hepatic resection. Ann Surg Treat Res. 2020 Mar;98(3):116-23. doi: 10.4174/astr.2020.98.3.116. Epub 2020 Feb 28. PMID: 32158731; PMCID: PMC7052393.
Bektas H, Yeyrek C, Kleine M, Vondran FW, Timrott K, Schweitzer N, et al. Surgical treatment for intrahepatic cholangiocarcinoma in Europe: a single center experience. J Hepatobiliary Pancreat Sci. 2015 Feb;22(2):131-7. doi: 10.1002/jhbp.158. Epub 2014 Aug 27. PMID: 25159731.
Spolverato G, Kim Y, Alexandrescu S, Marques HP, Lamelas J, Aldrighetti L, et al. Management and Outcomes of Patients with Recurrent Intrahepatic Cholangiocarcinoma Following Previous Curative-Intent Surgical Resection. Ann Surg Oncol. 2016 Jan;23(1):235-43. doi: 10.1245/s10434-015-4642-9. Epub 2015 Jun 10. PMID: 26059651.
Ali SM, Clark CJ, Zaydfudim VM, Que FG, Nagorney DM. Role of major vascular resection in patients with intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2013 Jun;20(6):2023-8. doi: 10.1245/s10434-012-2808-2. Epub 2012 Dec 21. PMID: 23263702.
Konstadoulakis MM, Roayaie S, Gomatos IP, Labow D, Fiel MI, Miller CM, et al. Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: operative results and long-term outcome. Surgery. 2008 Mar;143(3):366-74. doi: 10.1016/j.surg.2007.10.010. Epub 2007 Dec 21. PMID: 18291258.
Reames BN, Ejaz A, Koerkamp BG, Alexandrescu S, Marques HP, Aldrighetti L, et al. Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi-institutional analysis. J Surg Oncol. 2017 Aug;116(2):133-9. doi: 10.1002/jso.24633. Epub 2017 Apr 15. PMID: 28411373.
Bartsch F, Baumgart J, Hoppe-Lotichius M, Straub BK, Heinrich S, Lang H. Intrahepatic cholangiocarcinoma - influence of resection margin and tumor distance to the liver capsule on survival. BMC Surg. 2020 Apr 6;20(1):61. doi: 10.1186/s12893-020-00718-7. PMID: 32252724; PMCID: PMC7137203.
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