Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma.
ABSTRACT We conducted this study to assess the safety of performing right trisectionectomy with caudate lobectomy for hilar cholangiocarcinoma by analyzing postoperative mortality and morbidity, and to evaluate the effect of such procedure on pathological curability and long-term overall survival.
A retrospective clinicopathological analysis was performed for 16 hilar cholangiocarcinoma patients who underwent right trisectionectomy with caudate lobectomy from June 1999 to April 2003. The median follow-up period was 36.9 months. The preoperative Bismuth-Corlette type was type II in four patients, type III(A) in 10 patients, and type IV in two patients.
The median liver volume after hepatic resection was 21.9% of the total liver volume. Postoperative complications including one chronic liver failure developed in 12 patients, but no in-hospital deaths occurred. A postoperative pathological examination showed a cancer free margin in all of the proximal resection sites, although three cases had carcinoma in situ (CIS) lesions in the distal margin that were confirmed during surgery. The 1-, 3-, and 5-year overall survival rates were 94.1%, 64.2%, and 64.2%, respectively.
We obtained excellent survival rates without any in-hospital deaths following right trisectionectomy with caudate lobectomy. This procedure may be an effective surgical procedure that can be executed to achieve low mortality rate and high pathological curability for hilar cholangiocarcinomas, except for Bismuth type III(B).
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ABSTRACT: Hilar cholangiocarcinomas are often treated with liver resections. Hepatic dysfunction and infection are common postoperative complications. Although secondary bacterial peritonitis due to abdominal abscess or perforation is common, we report herein the first case of spontaneous bacterial peritonitis after hepatic resection. A 61-year-old male patient without underlying liver disease was diagnosed as having a Klatskin tumor, and a right trisectionectomy with caudate lobectomy was performed. From postoperative days 18-28, the patient gained 4.1 kg as ascites developed, and showed evidence of hepatic insufficiency with prolonged prothrombin time and jaundice. Computed tomography, performed at postoperative day 28 when fever had developed, showed only ascites without bowel perforation or abscess. When paracentesis was performed, the serum-ascites albumin gradient was 2.3 g/dL, indicating portal hypertension, and the ascites' polymorphonuclear cell count was 1,156/mm(3). Since the clinical, laboratory, and image findings were compatible with spontaneous bacterial peritonitis, we started empirical antibiotics without additional intervention. Follow-up analysis of the ascites after 48 hours revealed that the polymorphonuclear cell count had decreased markedly to 108/mm(3); the fever and leukocytosis had also improved. After 2 weeks of antibiotic treatment, the patient recovered well, and was discharged without any problem.Gut and liver 03/2010; 4(1):129-34. · 1.31 Impact Factor
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ABSTRACT: The purpose of the present study was to demonstrate that post-operative morbidity (PM) associated with resections of hilar cholangiocarcinoma (HCCA) is associated with short- and long-term patient survival. Between 1998 and 2008, 51 patients with a median age of 64 years underwent resection for HCCA at a single institution. Associations between survival and clinicopathologic factors, including peri- and post-operative variables, were studied using univariate and multivariate models. Seventy-six per cent of patients underwent major hepatectomy with resection of the extrahepatic bile ducts. The 30- and 90-day operative mortality was 10% and 12%. The overall incidence of PM was 69%, with 68% of all PM as major (Clavien grades III-V). No difference in operative blood loss or peri-operative transfusion rates was observed for patients with major vs. minor or no PM. Patients with major PM received adjuvant chemotherapy less frequently than patients with minor or no complications 29% vs. 52%, P= 0.15. The 1-, 3- and 5-year overall (OS) and disease-specific survival (DSS) rates for all patients were 65%, 36%, 29% and 77%, 46%, 35%, respectively. Using univariate and multivariate analysis, margin status (27% R1), nodal metastasis (35% N1) and major PM were associated with OS and DSS, P < 0.01. Major PM was an independent factor associated with decreased OS and DSS [hazard ratio (HR) = 3.6 and 2.8, respectively, P < 0.05]. The median DSS for patients with major PM was 14 months compared with 40 months for patients who experienced minor or no PM, P < 0.01. Extensive operations for HCCA can produce substantial post-operative morbidity. In addition to causing early mortality, major post-operative complications are associated with decreased long-term cancer-specific survival after resection of HCCA.HPB 02/2011; 13(2):139-47. · 1.94 Impact Factor
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ABSTRACT: BACKGROUND: Low resectability rate and poor survival outcomes after surgical resection for hilar cholangiocarcinoma are common in most institutions. We retrospectively reviewed the surgical outcomes of hilar cholangiocarcinoma in a tertiary institution focusing on the surgical procedures, radicalities, survival rates and independent prognostic factors. METHODS: Two hundred thirty patients who underwent surgical resection for hilar cholangiocarcinoma between 1995 and 2010 were retrospectively analysed based on the clinical variables, Bismuth-Corlette types, radicality of operation and survival rates. RESULTS: The median overall and disease-free survival time in the whole cohort were 39.1 and 19.2 months, respectively. Patients with type I or II tumour were more likely to undergo segmental bile duct resection than combined liver resection with lower R0 rates (68.2% and 76.1%, respectively). Liver resection (P < 0.001) and combined caudate lobectomy (P = 0.003) were associated with significantly higher R0 rates. Multivariate analysis showed that lymph node metastasis (P = 0.001), preoperative level of bilirubin above 3.0 mg/dL (P = 0.003) and positive resection margin (P = 0.033) were independent prognostic factors on overall survival. CONCLUSION: Liver resection and combined caudate lobectomy increased curative resection rates in hilar cholangiocarcinoma regardless of Bismuth-Corlette types. Preoperative biliary drainage should be performed in jaundiced patients to improve perioperative outcome and survival.ANZ Journal of Surgery 09/2012; · 1.50 Impact Factor