Surgical Resection of Hilar Cholangiocarcinoma: Analysis of Survival and Postoperative Complications

作者：Suguru Hasegawa, Iwao Ikai, Hideaki Fujii, Etsuro Hatano, Yasuyuki Shimahara · 发表于：World Journal of Surgery · 年份：2007 · DOI：10.1007/s00268-007-9001-y · 被引用次数：221 · 研究领域：Cholangiocarcinoma and Gallbladder Cancer Studies、Gallbladder and Bile Duct Disorders、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND: Surgery is the only potentially curative treatment for hilar bile duct cancer. This study sought to evaluate the efficacy and feasibility of surgical management of hilar bile duct carcinoma, including radical hepatectomy, at a single institution. METHODS: We performed a retrospective review of 49 consecutive patients who underwent surgery at our hospital between 1990 and 2003. RESULTS: Altogether, 44 of 49 patients underwent radical hepatectomy combined with caudate lobectomy and lymphadenectomy. One and four patients underwent partial hepatectomy or bile duct resection, respectively. No patients underwent preoperative portal vein embolization. The 5-year survival rate was 39.7%, with a median survival time of 3.75 years. The postoperative morbidity and mortality rates were 46.8% and 2.0%, respectively. Cox's proportional hazard model revealed that lymph node status and the residual tumor factor were independent prognostic factors. Multivariate analysis revealed that preoperative hyperbilirubinemia, postoperative complications, and extended surgical procedures were independently associated with postoperative hyperbilirubinemia. After potentially curative resection, 39.4% of patients suffered from disease recurrence. In 60% of the total cases, the sites of recurrence were distant metastases. CONCLUSION: Surgery, including radical hepatectomy combined with caudate lobectomy and lymph node dissection, is a feasible, effective treatment for hilar bile duct cancer.