title: Surgical treatment of perihilar cholangiocarcinoma: early results of en bloc portal vein resection.
abstract: OBJECTIVE
  The objective of this study was to analyse the safety, feasibility and survival outcomes of our treatment of perihilar cholangiocarcinoma (PHC) since the introduction of more aggressive approaches (en bloc, vascular and extended liver resections) in 2007.
  
  
  METHODS
  From July 2007 to December 2014, 32 consecutive patients with PHC underwent surgery with curative intent. Surgery with resection and reconstruction of the portal vein bifurcation and right hepatic artery was performed if necessary for a complete removal of the tumour. Perioperative data and postoperative histological findings, tumour recurrence rates and survival rates were recorded. Seventeen (53%) of the patients presented with stage IIIb or IV according to the UICC classification system.
  
  
  RESULTS
  The 5-year survival rate in our series was 45%, and this percentage increased to 65% when patients with advanced stage cancer (stage IIIb or higher) were excluded. We performed 3 arterials and 23 portal vein reconstruction. Twelve patients underwent extended hemihepatectomy. We achieved cancer-free margins in 19 patients (60%). Tumour stage and nodal involvement were the most important prognostic factors. The perioperative morbidity and mortality rates of this cohort were 72% (23) and 15.6% (5), respectively; these results were similar to data published by other groups.
  
  
  CONCLUSIONS
  An aggressive approach involving en bloc or extended liver resection combined with vascular reconstruction provides acceptable morbidity and mortality and increases the 5-year survival rate of PHC.
authors.affiliation: HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain. bistums@hotmail.com.
authors.forename: Víctor
authors.initials: V
authors.lastname: Molina
authors.affiliation: HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Sampson
authors.affiliation: HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
authors.affiliation: Department of Pathology, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Díaz
authors.affiliation: Department of Radiology, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Juan Ramon
authors.initials: JR
authors.lastname: Ayuso
authors.affiliation: HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Sánchez-Cabús
authors.affiliation: HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Fuster
authors.affiliation: HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Valdecasas
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D005240:Feasibility Studies; 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*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Hemihepatectomy; Hilar cholangiocarcinoma; Liver fuction; Surgery; Vascular resection