Abstract
Introduction: Surgery for perihilar cholangiocarcinoma (pCCA) is associated with high rates of postoperative morbidity and mortality. Extended liver resection (EXT) increases R0 resection rate and survival; however, patients with high perioperative risk are not suitable for extended resection. This study aimed to compare overall survival and surgical morbidity in patients with extended liver resection and parenchyma-preserving hepatectomy (PPH). Methods: Between January 2010 and November 2020, 113 consecutive patients with pCCA underwent surgery at our institution. Eighty-two patients were resected in curative intent. Sixty-four patients received extended liver resection, and 18 patients PPH. Outcomes of resections were evaluated. Results: There was no significant difference in overall survival in patients with PPH compared to extended liver resection (log-rank p = 0.286). Patients with PPH experienced lower rates of postoperative morbidity and mortality. There was no case of in-house mortality in PPH-resected patients compared to 10 cases (16%) in patients that received EXT (p = 0.073). Conclusion: PPH shows similar overall survival with lower rates of postoperative morbidity and mortality. Our findings support the role of a PPH, in selected patients with pCCA, that are not suitable for extended resection due to increased perioperative risk.
Journal Section:
Research Article
References
1.
Hartog
H
, Ijzermans
JNM
, van Gulik
TM
, Groot Koerkamp
B
. Resection of perihilar cholangiocarcinoma
. Surg Clin North Am
. 2016
;96
(2
):247
–67
. .2.
Banales
JM
, Marin
JJG
, Lamarca
A
, Rodrigues
PM
, Khan
SA
, Roberts
LR
, et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management
. Nat Rev Gastroenterol Hepatol
. 2020
;17
(9
):557
–88
. .3.
Ito
F
, Cho
CS
, Rikkers
LF
, Weber
SM
. Hilar cholangiocarcinoma: current management
. Ann Surg
. 2009
;250
(2
):210
–8
. .4.
DeOliveira
ML
, Cunningham
SC
, Cameron
JL
, Kamangar
F
, Winter
JM
, Lillemoe
KD
, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution
. Ann Surg
. 2007
;245
(5
):755
–62
. .5.
van Keulen
AM
, Buettner
S
, Erdmann
JI
, Pratschke
J
, Ratti
F
, Jarnagin
WR
, et al. Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk
. Br J Surg
. 2023
;110
(5
):599
–605
. .6.
Hemming
AW
, Reed
AI
, Fujita
S
, Foley
DP
, Howard
RJ
. Surgical management of hilar cholangiocarcinoma
. Ann Surg
. 2005
;241
(5
):693
–702
; discussion 699-702. .7.
Pichlmayr
R
, Lamesch
P
, Weimann
A
, Tusch
G
, Ringe
B
. Surgical treatment of cholangiocellular carcinoma
. World J Surg
. 1995
;19
(1
):83
–8
. .8.
Mansour
JC
, Aloia
TA
, Crane
CH
, Heimbach
JK
, Nagino
M
, Vauthey
JN
. Hilar cholangiocarcinoma: expert consensus statement
. HPB
. 2015
;17
(8
):691
–9
. .9.
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
. .10.
Jarnagin
WR
, Fong
Y
, DeMatteo
RP
, Gonen
M
, Burke
EC
, Bodniewicz
J
, et al. Staging, resect- ability, and outcome in 225 patients with hi- lar cholangiocarcinoma
. Ann Surg
. 2001
;234
(4
):507
–19
. .11.
van Keulen
AM
, Buettner
S
, Besselink
MG
, Busch
OR
, van Gulik
TM
, Ijzermans
JNM
, et al. Surgical morbidity in the first year after resection for perihilar cholangiocarcinoma
. HPB
. 2021
;23
(10
):1607
–14
. .12.
Franken
LC
, Rassam
F
, van Lienden
KP
, Bennink
RJ
, Besselink
MG
, Busch
OR
, et al. Effect of structured use of preoperative portal vein embolization on outcomes after liver resection of perihilar cholangiocarcinoma
. BJS Open
. 2020
;4
(3
):449
–55
. .13.
14.
Bismuth
H
, Corlette
MB
. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver
. Surg Gynecol Obstet
. 1975
;140
(2
):170
–8
.15.
Filmann
N
, Walter
D
, Schadde
E
, Bruns
C
, Keck
T
, Lang
H
, et al. Mortality after liver surgery in Germany
. Br J Surg
. 2019
;106
(11
):1523
–9
. .16.
Wiggers
JK
, Groot Koerkamp
B
, Cieslak
KP
, Doussot
A
, van Klaveren
D
, Allen
PJ
, et al. Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant
. J Am Coll Surg
. 2016
;223
(2
):321
–31.e1
. .17.
Kirstein
MM
, Vogel
A
. Epidemiology and risk factors of cholangiocarcinoma
. Visc Med
. 2016
;32
(6
):395
–400
. .18.
Mueller
M
, Breuer
E
, Mizuno
T
, Bartsch
F
, Ratti
F
, Benzing
C
, et al. Perihilar cholangiocarcinoma: novel benchmark values for surgical and oncological outcomes from 24 expert centers
. Ann Surg
. 2021
;274
(5
):780
–8
. .19.
Olthof
PB
, Miyasaka
M
, Koerkamp
BG
, Wiggers
JK
, Jarnagin
WR
, Noji
T
, et al. A comparison of treatment and outcomes of perihilar cholangiocarcinoma between Eastern and Western centers
. HPB
. 2019
;21
(3
):345
–51
. .20.
Nagino
M
, Ebata
T
, Yokoyama
Y
, Igami
T
, Sugawara
G
, Takahashi
Y
, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections
. Ann Surg
. 2013
;258
(1
):129
–40
. .21.
Nishio
H
, Nagino
M
, Nimura
Y
. Surgical management of hilar cholangiocarcinoma: the Nagoya experience
. HPB
. 2005
;7
(4
):259
–62
. .22.
Watanabe
Y
, Kuboki
S
, Shimizu
H
, Ohtsuka
M
, Yoshitomi
H
, Furukawa
K
, et al. A new proposal of criteria for the future remnant liver volume in older patients undergoing major hepatectomy for biliary tract cancer
. Ann Surg
. 2018
;267
(2
):338
–45
. .23.
van Keulen
AM
, Buettner
S
, Besselink
MG
, Busch
OR
, van Gulik
TM
, Ijzermans
JNM
, et al. Primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma
. Surgery
. 2021
;170
(4
):1024
–30
. .24.
van Keulen
AM
, Olthof
PB
, Buettner
S
, Bednarsch
J
, Verheij
J
, Erdmann
JI
, et al. The influence of hepatic steatosis and fibrosis on postoperative outcomes after major liver resection of perihilar cholangiocarcinoma
. Ann Surg Oncol
. 2023
;31
(1
):133
–141
. .25.
Olthof
PB
, Aldrighetti
L
, Alikhanov
R
, Cescon
M
, Groot Koerkamp
B
, Jarnagin
WR
, et al. Portal vein embolization is associated with reduced liver failure and mortality in high-risk resections for perihilar cholangiocarcinoma
. Ann Surg Oncol
. 2020
;27
(7
):2311
–8
. .26.
Nooijen
LE
, Swijnenburg
RJ
, Klümpen
HJ
, Verheij
J
, Kazemier
G
, van Gulik
TM
, et al. Surgical therapy for perihilar cholangiocarcinoma: state of the art
. Visc Med
. 2021
;37
(1
):18
–25
. .27.
Coelen
RJS
, Roos
E
, Wiggers
JK
, Besselink
MG
, Buis
CI
, Busch
ORC
, et al. Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial
. Lancet Gastroenterol Hepatol
. 2018
;3
(10
):681
–90
. .28.
Khan
AS
, Garcia-Aroz
S
, Ansari
MA
, Atiq
SM
, Senter-Zapata
M
, Fowler
K
, et al. Assessment and optimization of liver volume before major hepatic resection: current guidelines and a narrative review
. Int J Surg
. 2018
;52
:74
–81
. .29.
Benzing
C
, Krenzien
F
, Mieg
A
, Wolfsberger
A
, Andreou
A
, Nevermann
N
, et al. A tailored approach in lymph node-positive perihilar cholangiocarcinoma
. Langenbecks Arch Surg
. 2021
;406
(5
):1499
–509
. .30.
Wu
W
, Cheng
Q
, Chen
J
, Chen
D
, Feng
X
, Wu
J
. Left-side vs. right-side hepatectomy for hilar cholangiocarcinoma: a meta-analysis
. World J Surg Oncol
. 2021
;19
(1
):107
. .31.
Franken
LC
, Olthof
PB
, Erdmann
JI
, van Delden
OM
, Verheij
J
, Besselink
MG
, et al. Short- and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma: does left or right side matter
. Hepatobiliary Surg Nutr
. 2021
;10
(2
):154
–62
. .32.
Hasegawa
S
, Ikai
I
, Fujii
H
, Hatano
E
, Shimahara
Y
. Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications
. World J Surg
. 2007
;31
(6
):1256
–63
. .33.
Choi
IKA.GH
. Parenchyma preserving hepatetcomy in perihilarcholangiocarcinoma HPB (Oxford)
. 2019
. Vol. 21
; p. S387
–388
.34.
Kawarada
Y
, Isaji
S
, Taoka
H
, Tabata
M
, Das
BC
, Yokoi
H
. S4a + S5 with caudate lobe (S1) resection using the Taj Mahal liver parenchymal resection for carcinoma of the biliary tract
. J Gastrointest Surg
. 1999
;3
(4
):369
–73
. .35.
Tan
JW
, Hu
BS
, Chu
YJ
, Tan
YC
, Ji
X
, Chen
K
, et al. One-stage resection for Bismuth type IV hilar cholangiocarcinoma with high hilar resection and parenchyma-preserving strategies: a cohort study
. World J Surg
. 2013
;37
(3
):614
–21
. .36.
Chen
XP
, Lau
WY
, Huang
ZY
, Zhang
ZW
, Chen
YF
, Zhang
WG
, et al. Extent of liver resection for hilar cholangiocarcinoma
. Br J Surg
. 2009
;96
(10
):1167
–75
. .37.
Miyazaki
M
, Ito
H
, Nakagawa
K
, Ambiru
S
, Shimizu
H
, Okaya
T
, et al. Parenchyma-preserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma
. J Am Coll Surg
. 1999
;189
(6
):575
–83
. .38.
Lee
JH
, Hwang
DW
, Lee
SY
, Park
KM
, Lee
YJ
. The proximal margin of resected hilar cholangiocarcinoma: the effect of microscopic positive margin on long-term survival
. Am Surg
. 2012
;78
(4
):471
–7
. .39.
Seyama
Y
, Kubota
K
, Sano
K
, Noie
T
, Takayama
T
, Kosuge
T
, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate
. Ann Surg
. 2003
;238
(1
):73
–83
. .40.
Shinohara
K
, Ebata
T
, Shimoyama
Y
, Mizuno
T
, Yokoyama
Y
, Yamaguchi
J
, et al. A study on radial margin status in resected perihilar cholangiocarcinoma
. Ann Surg
. 2021
;273
(3
):572
–8
. .41.
Tran
TB
, Ethun
CG
, Pawlik
TM
, Schmidt
C
, Beal
EW
, Fields
RC
, et al. Actual 5-year survivors after surgical resection of hilar cholangiocarcinoma
. Ann Surg Oncol
. 2019
;26
(2
):611
–8
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