title: Combined liver and extrahepatic bile duct resection for biliary invasion of colorectal metastasis: a case-cohort analysis and systematic review.
abstract: BACKGROUND
  Colorectal liver metastases (CRLMs) with biliary invasion can be treated with a combined liver and extrahepatic bile duct resection. The aim of this study was to analyze outcomes of this procedure in a case-cohort analysis and systematic review.
  
  
  METHODS
  Consecutive patients who underwent a major liver resection for CRLM between 2003 and 2013 were selected from a single center prospective database, comparing patients with and without biliary invasion. A specific and a general search strategy were used to identify relevant articles in the systematic review.
  
  
  RESULTS
  Ten patients (13.2%) underwent combined liver and extrahepatic bile duct resection for CLRM with biliary invasion, among 76 patients included. An R0 resection was achieved in five of ten patients (50%); one of ten patients died postoperatively. Median overall survival was 19 months among patients with biliary invasion, versus 106 months among patients without biliary invasion (P=0.12). The systematic review yielded a large variability in 5-year survival after resection of CLRM with biliary invasion, ranging between 33-80%.
  
  
  CONCLUSIONS
  Surgical resection of CLRM with central biliary invasion is feasible, but survival in these patients tends to be lower due to a high rate of non-radical resections.
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Jimme K
authors: JK
authors: Wiggers
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Wouter W
authors: WW
authors: Te Riele
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Tristan H
authors: TH
authors: van Dongen
authors: Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands.
authors: Joanne
authors: J
authors: Verheij
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Olivier R C
authors: OR
authors: Busch
authors: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors: Thomas M
authors: TM
authors: van Gulik
keywords: Extrahepatic; biliary; colorectal; invasion; metastasis