Aged ; Bile Duct Neoplasms/mortality ; Bile Duct Neoplasms/surgery* ; Bile Ducts, Intrahepatic/surgery* ; Cholangiocarcinoma/mortality ; Cholangiocarcinoma/surgery* ; Female ; Hepatectomy* ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Operative Time ; Postoperative Complications/epidemiology ; Retrospective Studies ; Survival Rate ; Treatment Outcome
Keywords
Bile Duct ; Liver Resection ; Portal Vein Embolization ; Hilar Cholangiocarcinoma ; Bile Duct Resection
Abstract
BACKGROUND:
In patients with Bismuth type I and II hilar cholangiocarcinoma (HCCA), bile duct resection alone has been the conventional approach. However, many authors have reported that concomitant liver resection improved surgical outcomes.
METHODS:
Between January 2000 and January 2012, 52 patients underwent surgical resection for a Bismuth type I and II HCCA (type I: n = 22; type II: n = 30). Patients were classified into two groups: concomitant liver resection (n = 26) and bile duct resection alone (n = 26).
RESULTS:
Bile duct resection alone was performed in 26 patients. Concomitant liver resection was performed in 26 patients (right side hepatectomy [n = 13]; left-side hepatectomy [n = 6]; volume-preserving liver resection [n = 7]). All liver resections included a caudate lobectomy. Patient and tumor characteristics did not differ between the two groups. Although concomitant liver resection required longer operating time (P < 0.001), it had a similar postoperative complication rate (P = 0.764), high curability (P = 0.010), and low local recurrence rate (P = 0.006). Concomitant liver resection showed better overall survival (P = 0.047).
CONCLUSIONS:
Concomitant liver resection should be considered in patients with Bismuth type I and II HCCA.