Journal article Open Access
Romic, Ivan; Petrovic, Igor; Golem, Ante Zvonimir; Kinda, Emil; Kekez, Tihomir; Augustin, Goran; Silovski, Hrvoje; Bruketa, Tomislav; Moric, Trpimir; Jelincic, Zeljko
Background: Our study evaluates surgical outcomes of patients treated for perihilar cholangiocarcinoma in a single institution and demonstrates postoperative (90 days) morbidity and mortality rates and potential prognostic factors associated with complications.
Methods: Medical records of all patients with a diagnosis of perihilar cholangiocarcinoma (pCC) between 2007 and 2017 who underwent a surgical procedure at the University hospital centre Zagreb, were retrospectively evaluated. Statistical analysis to determine predictors of postoperative mortality was performed using the Chi-square test and Fisher exact probability test where appropriate.
Results: Out of 52 surgically treated patients, 43 underwent radical and 9 palliative procedures. Hilar resection and hilar resection along with right hepatectomy were the most commonly performed procedures in 34 radically treated patients. Overall morbidity and mortality rates were 46% and 5.7%, respectively. Significantly higher morbidity rate was observed in a group of patient with untreated preoperative jaundice and in those aged 70 and over.
Conclusion: Current guidelines favor extension of radicality in treatment of pCC by performing left or right hepatectomy in addition to hilar resection. This may increase R0 resection rates and prolong disease free survival. Our experience shows similar mortality/morbidity rates as reported in other centers and confirms that in selected patients, concomitant hepatectomy for perihilar pCC is a safe and feasible surgical strategy.
ACC2019No1 Surgical treatment of perihilar cholangiocarcinoma 10 year experience at a single institution.pdf
Hu HJ, Mao H, Shrestha A, et al. Prognostic factors and long-term outcomes of perihilar cholangiocarcinoma: A single-institution experience in China. World J Gastroenterol. 2016;22(8):2601-10.
Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BS J, Youssef BA M, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 225 patients with perihilar cholangiocarcinoma. Ann Surg. 2001;234:507–517; discussion 517-519.
Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for perihilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg. 1999;230:663–671.
Kow AW, Wook CD, Song SC, Kim WS, Kim MJ, Park HJ, Heo JS, Choi SH. Role of caudate lobectomy in type III A and III B perihilar cholangiocarcinoma: a 15-year experience in a tertiary institution. World J Surg. 2012;36:1112–1121.
Lillemoe KD, Cameron JL. Surgery for perihilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobiliary Pancreat Surg. 2000;7:115–121.
Mantel HT, Westerkamp AC, Adam R, et al. Strict Selection Alone of Patients Undergoing Liver Transplantation for Perihilar Cholangiocarcinoma Is Associated with Improved Survival. PLoS One. 2016;11(6):e0156127. Published 2016 Jun 8. doi:10.1371/journal.pone.0156127
Ramos E. Principles of surgical resection in perihilar cholangiocarcinoma. World J Gastrointest Oncol. 2013;5:139–146.
Zhang W, Yan LN. Perihilar cholangiocarcinoma: Current therapy. World J Gastrointest Pathophysiol. 2014;5(3):344-54.