Local surgical resection of hilar cholangiocarcinoma: is there still a place?
In recent decades, surgical treatment of hilar cholangiocarcinoma has moved toward liver surgery in association with biliary resection in order to increase radicality and to achieve better survival. Results of local resection compared with hepatectomy associated with bile duct resection and its actual indications have to be clarified. A systematic review of relevant studies published before December 2007 was performed. Original published studies comparing the results of isolated local excision with those of hepatectomy associated with bile duct resection were identified and the reported results were synthesized. The pathologic data suggest that isolated bile duct resection cannot be adequate: required wide surgical margins; neoplastic extension along perineural sheaths; Segment 1 neoplastic invasion. Considering postoperative outcomes, in the 1990s, local resection had significantly lower mortality rates than liver resection. In recent years, the short-term results of liver surgery have improved significantly, while mortality rates have decreased. The R0 resection rate is significantly higher after associated liver resection. Comparison of survival results between local resection and associated liver surgery is difficult because, in the majority of series, the treatment was planned according to tumor extension. Better long-term outcomes have been reported after liver resection than after isolated bile duct resection, even for Bismuth-Corlette type I-II cholangiocarcinoma. Long-term survivors after local resection have been reported in a few selected patients with Bismuth-Corlette type I Tis-T1 or papillary neoplasm.
Capussotti
L
L
Ospedale Mauriziano Umberto I, Turin, Italy. lcapussotti@mauriziano.it
Vigano
L
L
Ferrero
A
A
Muratore
A
A
Ann Surg. 1996 Oct;224(4):463-73; discussion 473-5
8857851
Cancer. 1997 Jan 1;79(1):26-34
8988723
Ann Surg. 1999 Nov;230(5):663-71
10561090
Surg Gynecol Obstet. 1986 Feb;162(2):153-8
3945893
Ann Surg. 1993 Jan;217(1):20-7
8380975
Ann Surg. 2003 Jul;238(1):73-83
12832968
Ann Surg. 1996 Nov;224(5):628-38
8916878
Am J Surg. 1990 Jan;159(1):91-7; discussion 97-8
1688486
J Hepatobiliary Pancreat Surg. 2000;7(2):155-62
10982608
Surgery. 1990 Jun;107(6):597-604
2162082
Ann Surg. 2005 Jan;241(1):77-84
15621994
Ann Surg. 1999 Aug;230(2):266-75
10450742
Br J Surg. 2002 Oct;89(10):1260-7
12296893
J Am Coll Surg. 2002 Nov;195(5):641-7
12437251
Ann Surg. 2004 Jul;240(1):95-101
15213624
J Hepatobiliary Pancreat Surg. 2000;7(2):148-54
10982607
Ann Surg. 2006 Aug;244(2):230-9
16858185
Ann Surg. 2007 May;245(5):755-62
17457168
Ann Surg. 2003 Jul;238(1):84-92
12832969
Surgery. 1994 Apr;115(4):445-51
8165536
Ann Surg. 2006 Aug;244(2):240-7
16858186
J Hepatobiliary Pancreat Surg. 2000;7(2):111-4
10982601
Ann Surg. 1998 Sep;228(3):385-94
9742921
Surgery. 1998 Feb;123(2):131-6
9481397
Ann Surg. 1999 Jan;229(1):76-83
9923803
Cancer. 1989 Aug 1;64(3):658-66
2545324
Ann Oncol. 1999;10 Suppl 4:243-6
10436832
World J Surg. 1993 Jan-Feb;17(1):85-92; discussion 92-3
8447147
Ann Surg. 1992 Jan;215(1):31-8
1309988
Ann Surg. 1999 Dec;230(6):808-18; discussion 819
10615936
J Hepatobiliary Pancreat Surg. 2000;7(2):128-34
10982604
World J Surg. 1990 Jul-Aug;14(4):535-43; discussion 544
2166381
Surgery. 1990 Sep;108(3):572-80
2204130
Ann Surg. 2001 Oct;234(4):507-17; discussion 517-9
11573044
Ann Surg Oncol. 2006 Jun;13(6):872-80
16614876
Ann Surg. 1996 Apr;223(4):384-94
8633917
Ann Surg. 2000 Aug;232(2):166-74
10903592
Clin Oncol (R Coll Radiol). 2006 Nov;18(9):669-77
17100152
Ann Surg. 2007 Dec;246(6):1052-7
18043110