title: Aggressive surgical resection for hilar cholangiocarcinoma: is it justified? Audit of a single center's experience.
abstract: BACKGROUND
  The current study presents our experience with resectional surgery for patients with hilar cholangiocarcinoma (HC).
  
  
  METHODS
  Medical records of 73 HC patients who were referred to our department between 1988 and 2006 were reviewed. Resectability rate, surgical mortality, and factors contributing to survival were investigated.
  
  
  RESULTS
  Resectional surgery was performed in 59 patients (80.8%), 51 of whom (86.4%) underwent major hepatic resection. Negative margins were obtained in 35 of 51 patients (68.6%) and were associated with right-sided hepatectomy (80% vs 20%, P = .049). In-hospital mortality and morbidity were 6.8% and 25.4%, respectively. One-, 3- and 5-year survival rates after liver resection were 86%, 48.9%, and 34.9%, respectively. Histologic differentiation, left-sided hepatectomy, and inferior vena cava resection independently predicted survival. Patients undergoing R1 hepatectomy had significantly improved 5-year survival rates compared with patients who were unresectable (P <.01).
  
  
  CONCLUSIONS
  Major hepatic resections with concomitant vascular resection and reconstruction, when needed, are justified for patients with Bismuth type III and IV hilar cholangiocarcinoma with negative nodes. Reluctance to incorporate segments V and/or VIII into a left lobectomy often results in tumor-positive margins and unfavorable prognosis. Resections for hilar lesions less than stage IVB, even when resulting in microscopically positive margins, confer prolonged survival compared with untreated patients. The results are further improved for patients with well-differentiated HC.
authors.affiliation: Recanati-Miller Transplantation Institute, Hippocration Hospital of Athens, Athens Medical School, Athens, Greece. manousos.konstadoulakis@mountsinai.org
authors.forename: Manousos M
authors.initials: MM
authors.lastname: Konstadoulakis
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
authors.forename: Ilias P
authors.initials: IP
authors.lastname: Gomatos
authors.forename: Daniel
authors.initials: D
authors.lastname: Labow
authors.forename: Maria-Isabell
authors.initials: MI
authors.lastname: Fiel
authors.forename: Charles M
authors.initials: CM
authors.lastname: Miller
authors.forename: Myron E
authors.initials: ME
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D016019:Survival Analysis; D014682:Vena Cava, Inferior / Q000601:surgery