The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases.

BACKGROUND. Surgical strategy for hilar cholangiocarcinoma often includes hepatectomy, but the role of portal vein resection (PVR) remains controversial. In this study, the authors sought to identify factors associated with outcome after surgical management of hilar cholangiocarcinoma and examined the impact of PVR on survival. Three hundred five patients who underwent curative-intent surgery for hilar cholangiocarcinoma between 1984 and 2010 were identified from an international, multi-institutional database. Clinicopathologic data were evaluated using univariate and multivariate analyses. Most patients had hilar cholangiocarcinoma with tumors classified as T3/T4 (51.1%) and Bismuth-Corlette type II/III (60.9%). Resection involved extrahepatic bile duct resection (EHBR) alone (26.6%); or hepatectomy and EHBR without PVR (56.7%); or combined hepatectomy, EHBR, and PVR (16.7%). Negative resection (R0) margin status was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 64.2%; with PVR, 66.7%) versus EHBR alone (54.3%; P < .001). The median number of lymph nodes assessed was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 6 lymph nodes; with PVR, 4 lymph nodes) versus EHBR alone (2 lymph nodes; P < .001). The 90-day mortality rate was lower for patients who underwent EHBR alone (1.2%) compared with the rate for patients who underwent hepatectomy plus EHBR (without PVR, 10.6%, with PVR, 17.6%; P < .001). The overall 5-year survival rate was 20.2%. Factors that were associated with an adverse prognosis included lymph node metastasis (hazard ratio [HR], 1.79; P = .002) and R1 margin status (HR, 1.81; P < .001). Microscopic vascular invasion did not influence survival (HR, 1.23; P = .19). Among the patients who underwent hepatectomy plus EHBR, PVR was not associated with a worse long-term outcome (P = .76). EHBR alone was associated with a greater risk of positive surgical margins and worse lymph node clearance. The current results indicated that hepatectomy should be considered the standard treatment for hilar cholangiocarcinoma, and PVR should be undertaken when necessary to extirpate all disease. Combined hepatectomy, EHBR, and PVR can offer long-term survival in some patients with advanced hilar cholangiocarcinoma.

de Jong MC ，Marques H ，Clary BM ，Bauer TW ，Marsh JW ，Ribero D ，Majno P ，Hatzaras I ，Walters DM ，Barbas AS ，Mega R ，Schulick RD ，Choti MA ，Geller DA ，Barroso E ，Mentha G ，Capussotti L ，Pawlik TM ... -  《-》

Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases.

Ebata T ，Nagino M ，Kamiya J ，Uesaka K ，Nagasaka T ，Nimura Y ... -  《-》

Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not?

Miyazaki M ，Kato A ，Ito H ，Kimura F ，Shimizu H ，Ohtsuka M ，Yoshidome H ，Yoshitomi H ，Furukawa K ，Nozawa S ... -  《SURGERY》

Outcomes of vascular resection associated with curative intent hepatectomy for intrahepatic cholangiocarcinoma.

We aimed to investigate the impact of vascular resection (VR) on postoperative outcomes and survival of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma (ICC). A retrospective analysis of a multi-institutional series of 270 patients with resected ICC was carried out. Patients were divided into three groups: portal vein VR (PVR), inferior vena cava VR (CVR) and no VR (NVR). Univariate and multivariate analysis were applied to define the impact of VR on postoperative outcomes and survival. Thirty-one patients (11.5%) underwent VR: 15 (5.6%) to PVR and 16 (5.9%) to CVR. R0 resection rates were 73.6% in NVR, 73.3% of PVR and 68.8% in CVR. The postoperative mortality rate was increased in VR groups: 2.5% in NVR, 6.7% in PVR and 12.5% in CVR. The 5-years overall survival (OS) rates progressively decreased from 38.4% in NVR, to 30.1% in CVR and to 22.2% in PVR, p = 0.030. However, multivariable analysis did not confirm an association between VR and prognosis. The following prognostic factors were identified: size ≥50 mm, patterns of distribution of hepatic nodules (single, satellites or multifocal), lymph-node metastases (N1) and R1 resections. In the VR group the 5-years OS rate in patients without lymph-node metastases undergoing R0 resection (VRR0N0) was 44.4%, while in N1 patients undergoing R1 resection was 20% (p < 0.001). Vascular resection (PVR and CVR) is associated with higher operative risk, but seems to be justified by the good survival results, especially in patients without other negative prognostic factors (R0N0 resections).

Conci S ，Viganò L ，Ercolani G ，Gonzalez E ，Ruzzenente A ，Isa G ，Salaris C ，Fontana A ，Bagante F ，Pedrazzani C ，Campagnaro T ，Iacono C ，De Santibanes E ，Pinna DA ，Torzilli G ，Guglielmi A ... -  《-》

Long-term outcome and prognostic factors of intrahepatic cholangiocarcinoma involving the hepatic hilus versus hilar cholangiocarcinoma after curative-intent resection: Should they be recognized as perihilar cholangiocarcinoma or differentiated?

Perihilar cholangiocarcinoma is defined as tumors arising predominantly at or near the biliary confluence, potentially consisting of two types: hilar cholangiocarcinoma (HC) and intrahepatic cholangiocarcinoma involving the hepatic hilum (hICC). However, whether hICC and HC should be strictly distinguished or combined remains highly controversial. We aimed to compare the clinicopathological characteristics, prognostic factors and long-term outcome of hICC versus HC after curative-intent resection. Between January 1998 and June 2015, a total of 325 patients with hICC (n = 146) and HC (n = 179) who underwent curative-intent resection were enrolled. The medical records of these patients were retrospectively reviewed. Portal vein invasion, larger tumors, and later T stage were significantly more common in hICC group. A total of 110 (75.3%) hICC patients and 119 (66.5%) HC patients experienced tumor recurrences, respectively. The median recurrence-free survival (RFS) and overall survival (OS) of hICC patients were significantly worse than those of HC patients (median RFS, 14.3 versus 22.7 months, P = 0.014; median OS, 21.7 versus 30.6 months, P = 0.032). Multivariate analysis revealed tumor size, satellite nodules, surgical margin, and histological grade as independent factors for OS in hICC patients. On the other hand, the presence of liver parenchyma invasion, portal invasion, lymphovascular invasion, later N stage, and positive surgical margin were associated with shorter OS in HC patients. hICC showed distinct clinicopathological features, more aggressive biological behaviors, different prognostic factors, and worse prognosis in comparison with HC. Therefore, making a strict distinction between hICC and HC is necessary.

Lu J ，Li B ，Li FY ，Ye H ，Xiong XZ ，Cheng NS ... -  《-》