title: Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma.
abstract: 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).
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
authors.forename: Kwang Yeol
authors.initials: KY
authors.lastname: Paik
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Choi
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Chung
authors.forename: Kyung Tae
authors.initials: KT
authors.lastname: Kang
authors.forename: Sang Bum
authors.initials: SB
authors.lastname: Kim
mesh_terms: 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