The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma.
BACKGROUND
The numbers of margin-negative resections and survival times have greatly improved because of a more aggressive surgical approach to resectable hilar cholangiocarcinoma (Klatskin tumour). It was shown initially by Japanese authors that complete resection of the caudate lobe together with partial hepatectomy leads to more margin-negative resections. However, this concept has not been unanimously taken up by Western authors. The aim of this study was to examine the role of complete caudate lobe resection in our series of resected hilar cholangiocarcinomas.


METHODS
Between January 1993 and January 2003, 54 patients underwent resection for Klatskin tumours. These patients were divided into two groups, according to the two 5-year periods in which they had been operated. In the first period, patients did not routinely undergo complete excision of the caudate lobe, whereas in the second period, partial liver resection was combined with complete excision of the caudate lobe in 15 patients. These two patient groups were evaluated with respect to postoperative morbidity and mortality, microscopic tumour margins and survival time.


RESULTS
Postoperative complications occurred in 59% of patients in total, while overall mortality was 11%. No difference was found in postoperative morbidity or mortality between the two periods. A significantly higher number of margin-negative resections was found in the second 5-year period, together with improved survival.


CONCLUSIONS
Concomitant complete excision of segment 1 for patients with hilar cholangiocarcinoma did not lead to increased morbidity or mortality. Therefore the addition of complete excision of segment 1 is a safe procedure contributing to a higher rate of R0 resections and improved survival.
Dinant
Sander
S
Department of Surgery, Academic Medical Center Amsterdam, the Netherlands.
Gerhards
Michael F
MF
Busch
Olivier R C
OR
Obertop
Hugo
H
Gouma
Dirk J
DJ
Van Gulik
Thomas M
TM