Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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).
Paik
Kwang Yeol
KY
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
Choi
Dong Wook
DW
Chung
Jun Chul
JC
Kang
Kyung Tae
KT
Kim
Sang Bum
SB
D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001706:Biopsy; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002758:Cholangiography; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome