title: Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma.
abstract: OBJECTIVE
  Long-term results after liver resection for hilar cholangiocarcinoma are still not satisfactory. Previously, we described a survival advantage of patients who undergo combined right trisectionectomy and portal vein resection, a procedure termed "hilar en bloc resection." The present study was conducted to analyze its oncological effectiveness compared to conventional hepatectomy.
  
  
  METHODS
  During hilar en bloc resection, the extrahepatic bile ducts were resected en bloc with the portal vein bifurcation, the right hepatic artery, and liver segments 1 and 4 to 8. With this "no-touch" technique, preparation of the hilar vessels in the vicinity of the tumor was avoided. The long-term outcome of 50 consecutive patients who underwent curative (R0) hilar en bloc resection between 1990 and 2004 was compared to that of 50 consecutive patients who received curative conventional major hepatectomy for hilar cholangiocarcinoma (perioperative deaths excluded).
  
  
  RESULTS
  The 1-, 3-, and 5-year survival rates after hilar en bloc resection were 87%, 70%, and 58%, respectively, which was significantly higher than after conventional major hepatectomy. In the latter group, 1-, 3-, and 5-year survival rates were 79%, 40%, and 29%, respectively (P = 0.021). Tumor characteristics were comparable in both groups. A high number of pT3 and pT4 tumors and patients with positive regional lymph nodes were present in both groups. Multivariate analysis identified hilar en bloc resection as an independent prognostic factor for long-term survival (P = 0.036).
  
  
  CONCLUSIONS
  In patients with central bile duct carcinomas, hilar en bloc resection is oncologically superior to conventional major hepatectomy, providing a chance of long-term survival even in advanced tumors.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany. peter.neuhaus@charite.de
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Armin
authors.initials: A
authors.lastname: Thelen
authors.forename: Sven
authors.initials: S
authors.lastname: Jonas
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Wilfried
authors.initials: W
authors.lastname: Veltzke-Schlieker
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
mesh_terms: D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011169:Portal Vein / Q000601:surgery; D015996:Survival Rate