Does portal vein resection with hepatectomy improve survival in locally advanced hilar cholangiocarcinoma?
OBJECTIVE
Although portal vein resection (PVR) can increase the respectability and curability in locally invading hilar cholangiocarcinoma, there are still controversies in regards to the balance between the risk and the benefit. The present study retrospectively assessed the safety and survival impact of PVR in locally advanced hilar cholangiocarcinoma (HCCA).


METHODS
259 patients undergoing surgical resection for HCCA between June 1989 and June 2005 were divided into two groups, 51 who underwent PVR (PVR+) and 208 who did not (PVR-). We compared survival and clinicopathological data between these two groups.


RESULTS
The 5-yr survival rate of PVR+ group (22.8%) was significantly lower than one of PVR- group (30.9%), but 7 of 51 patients (13.7%) have survived more than 5 yr. Five operative mortalities (9.8%) occurred in PVR+ group, but only 1 of 5 mortalities was directly related to PVR. The morbidity rate and postoperative liver function did not differ between two groups. In the PVR+ group, 28 (54.9%) had actual tumor invasion into the portal vein, but tumor invasion demonstrated no effect on survival.


CONCLUSIONS
Although PVR + group demonstrated low survival rate than PVR- group, PVR can offer long-term survival in more than 1 of 10 locally advanced HCCA. However, operative mortality should be lowered to apply PVR in hepatectomy for HCCA.
Song
Gi-Won
GW
Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Hwang
Shin
S
Kim
Ki-Hun
KH
Cho
Yong-Pil
YP
Ahn
Chul-Soo
CS
Moon
Deok-Bog
DB
Ha
Tae-Yong
TY
D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome