title: One-stage resection for Bismuth type IV hilar cholangiocarcinoma with high hilar resection and parenchyma-preserving strategies: a cohort study.
abstract: BACKGROUND
  Bismuth type IV hilar cholangiocarcinoma (HC) tumors are usually considered unresectable. The strategies of high hilar resection while preserving liver parenchyma can achieve potentially one-stage curative resection for this condition. The aim of the present study was to investigate the feasibility and safety of available strategies.
  
  
  METHODS
  Fifty-one consecutive patients with bismuth type IV HC who underwent one-stage resection were retrospectively reviewed with regard to curative resection rate, remnant liver volume, morbidity, mortality, and survival time.
  
  
  RESULTS
  The total median survival time was 29 months. The R(0) (curative resection) rate was 57.8%. The ratio of the remnant liver volume (RLV) to the standard liver volume (SLV) ranged from 35.0 to 60.6%, with a mean of 44.5%. The in-hospital mortality and morbidity rates were 3.9 and 37.2%, respectively. In the R0 patients' survival, there was not a significant difference between bilioenteric anastomosis and hepatoenteric anastomosis (P = 0.714).
  
  
  CONCLUSIONS
  Combined caudate lobe and high hilar resection (CCHR) is technically safe and oncologically justifiable and could be adopted with a high cure rate as a one-stage resection procedure for most patients with Bismuth type IV HC whose total bilirubin level is less than 20 mg/L and whose direct bilirubin is more than 60% of total bilirubin.
authors.affiliation: PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China. 626962213@qq.com
authors.forename: Jing Wang
authors.initials: JW
authors.lastname: Tan
authors.forename: Ben Shun
authors.initials: BS
authors.lastname: Hu
authors.forename: Ya Juan
authors.initials: YJ
authors.lastname: Chu
authors.forename: Yun Chang
authors.initials: YC
authors.lastname: Tan
authors.forename: Xu
authors.initials: X
authors.lastname: Ji
authors.forename: Ke
authors.initials: K
authors.lastname: Chen
authors.forename: Xiang Min
authors.initials: XM
authors.lastname: Ding
authors.forename: Aiqun
authors.initials: A
authors.lastname: Zhang
authors.forename: Fei
authors.initials: F
authors.lastname: Chen
authors.forename: Jia Hong
authors.initials: JH
authors.lastname: Dong
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; D001707:Biopsy, Needle; D002681:China; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome