title: Portal vein resection for hilar cholangiocarcinoma.
abstract: Hilar cholangiocarcinoma remains a difficult challenge for the surgeon. Achieving negative surgical margins when resecting this relatively uncommon tumor is technically demanding as a result of the close proximity of the bile duct bifurcation to the vascular inflow of the liver. A recent advance in surgical treatment is the addition of portal vein resection to the procedure. Resection of the portal vein increases the number of patients offered a potentially curative approach but is technically more difficult and may increase the risk of the procedure. This study reviews the results of portal vein resection for hilar cholangiocarcinoma. Between 1998 and 2005, 60 patients underwent potentially curative resections of hilar cholangiocarcinoma. Mean patient age was 64 +/- 12 years (range, 24-85 years). Liver resections performed along with biliary resection included 49 trisegmentectomies (37 right, 12 left) and 10 lobectomies (8 left, 2 right). One patient had only the bile duct resected. Four patients also had simultaneous pancreaticoduodenectomy performed. Twenty-six patients required portal vein resection and reconstruction to achieve negative margins, 3 of which also required reconstruction of the hepatic artery. Operative mortality was 8 per cent with an overall complication rate of 40 per cent. Patients who underwent portal vein resection had an operative mortality of 4 per cent, which was not different from the 12 per cent mortality in patients who did not undergo portal vein resection (P = 0.39). There was no difference in actuarial patient survival between patients who underwent portal vein resection and those who did not (5-year survival 39 per cent vs. 41 per cent, P = not significant). Negative margins were achieved in 80 per cent of cases and were associated with improved survival (P < 0.01). Five-year actuarial survival in patients undergoing resection with negative margins was 45 per cent. There was no difference in margin status or long-term survival between those patients who underwent portal vein resection and those who did not. Only negative margin status was associated with improved survival by multivariate analysis. Portal vein resection for hilar cholangiocarcinoma is safe and allows a chance for long-term survival in otherwise unresectable patients.
authors.affiliation: University of Florida Center for Hepatobiliary Disease, College of Medicine, Department of Surgery, Gainesville, Florida 32610-0286, USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Hemming
authors.forename: Robin D
authors.initials: RD
authors.lastname: Kim
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Mekeel
authors.forename: Shiro
authors.initials: S
authors.lastname: Fujita
authors.forename: Alan I
authors.initials: AI
authors.lastname: Reed
authors.forename: David P
authors.initials: DP
authors.lastname: Foley
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Howard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002423:Cause of Death; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012449:Safety; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate