title: Resection and reconstruction of the hepatic artery for advanced perihilar cholangiocarcinoma: result of arterioportal shunting.
abstract: BACKGROUND
  The clinical impact of concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma remains unclear. Microvascular anastomosis is typically used for arterial reconstruction, but we have proposed arterioportal shunting (APS) as an alternative procedure. The aims of this retrospective study were to evaluate concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma patients, to evaluate the safety and survival impact of APS, and to evaluate whether APS offers a good alternative to microvascular reconstruction.
  
  
  METHODS
  Thirty-nine patients with perihilar cholangiocarcinoma who required arterial reconstructions were retrospectively evaluated.
  
  
  RESULTS
  No significant difference was seen in overall incidence of postoperative complications between groups, but the incidence of liver abscess formation was significantly higher in the APS group. The cumulative 5-year survival rate was 15% in patients undergoing concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma. No significant differences in survival were identified between the microvascular (MV) and APS groups. Cumulative 5-year survival rates were 18% in the MV group and 11% in the APS group.
  
  
  CONCLUSIONS
  Concomitant arterial resection and reconstruction are feasible for patients with perihilar cholangiocarcinoma. Microvascular reconstruction should be used as the first-line strategy for these patients, with APS indicated only when the artery is unable to be microscopically anastomosed.
authors: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan, drnoji@med.hokudai.ac.jp.
authors: Takehiro
authors: T
authors: Noji
authors: Takahiro
authors: T
authors: Tsuchikawa
authors: Keisuke
authors: K
authors: Okamura
authors: Toru
authors: T
authors: Nakamura
authors: Eiji
authors: E
authors: Tamoto
authors: Toshiaki
authors: T
authors: Shichinohe
authors: Satoshi
authors: S
authors: Hirano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
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