title: Impact of portal vein resection on oncologic long-term outcome in patients with hilar cholangiocarcinoma.
abstract: BACKGROUND
  Liver resection (LR) for hilar cholangiocarcinoma (HCA) remains challenging because of the occurrence of unanticipated vascular and longitudinal bile duct invasion. Operative strategies to achieve negative resection margins vary, and the benefit of routine portal vein resection (PVR) is discussed controversially.
  
  
  METHODS
  The data of 60 consecutive patients who underwent LR for HCA were analyzed. Twenty-one patients (35.0%) underwent LR plus PVR and 39 (65.0%) LR only. Clinicopathologic data were evaluated by the use of uni- and multivariate analyses.
  
  
  RESULTS
  The majority of resections was performed for Bismuth-Corlette type III/IV tumors (97.3%). Hepatectomy involved trisectionectomies in 41 patients (68.3%). R1 resection margin status was identified as adverse prognosis factor for survival (hazard ratio 3.61; P = .003). PVR increased the perioperative morbidity (P = .04). The 90-day mortality rate was comparable between both groups (P = .70). Negative resection margin status was similar between groups (P = .70). The lymph node clearance was equal (P = .86). PVR was not associated with a beneficial long-term outcome, the 5-year and disease-free survival were comparable (LR only 17.8% vs LR plus PVR 20.0% [P = .89] and LR only 10.6% vs LR plus PVR 21.4% [P = .63]). PVR was no prognostic factor for tumor-dependent or disease-free survival (hazard ratio 0.64; P = .26 and hazard ratio 0.76; P = .47).
  
  
  CONCLUSIONS
  The presented data indicate that simultaneous PVR has no beneficial impact on oncologic long-term outcome in patients undergoing LR for HCA. Because it increases the perioperative morbidity, a recommendation for routine application cannot be given.
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Hoffmann
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Luible
authors.affiliation: Institute of Pathology, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Goeppert
authors.affiliation: Department of Internal Medicine, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Weiss
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls-University, Heidelberg, Germany. Electronic address: markus.buechler@med.uni-heidelberg.de.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome