One-stage Resection for Bismuth Type IV Hilar Cholangiocarcinoma with High Hilar Resection and Parenchyma-preserving Strategies: A Cohort Study
Corresponding Author
Jing Wang Tan
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
[email protected]Search for more papers by this authorBen Shun Hu
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorYa Juan Chu
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorYun Chang Tan
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorXu Ji
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorKe Chen
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorXiang Min Ding
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorAiqun Zhang
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorFei Chen
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorJia Hong Dong
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorCorresponding Author
Jing Wang Tan
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
[email protected]Search for more papers by this authorBen Shun Hu
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorYa Juan Chu
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorYun Chang Tan
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorXu Ji
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorKe Chen
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorXiang Min Ding
Hepatobiliary Surgery Department, Northern Jiangsu People’s Hospital, Yangzhou University, 225001 Yangzhou, People’s Republic of China
Search for more papers by this authorAiqun Zhang
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorFei Chen
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorJia Hong Dong
PLA General Hospital, Institute of Hepatobiliary Surgery, 28 Fuxing Road, Haidian District, 100853 Beijing, People’s Republic of China
Search for more papers by this authorJing Wang Tan and Ben Shun Hu contributed equally to this work.
Abstract
Background
Bismuth type IV hilar cholangiocarcinoma (HC) tumors are usually considered unresectable. The strategies of high hilar resection while preserving liver parenchyma can achieve potentially one-stage curative resection for this condition. The aim of the present study was to investigate the feasibility and safety of available strategies.
Methods
Fifty-one consecutive patients with bismuth type IV HC who underwent one-stage resection were retrospectively reviewed with regard to curative resection rate, remnant liver volume, morbidity, mortality, and survival time.
Results
The total median survival time was 29 months. The R0 (curative resection) rate was 57.8 %. The ratio of the remnant liver volume (RLV) to the standard liver volume (SLV) ranged from 35.0 to 60.6 %, with a mean of 44.5 %. The in-hospital mortality and morbidity rates were 3.9 and 37.2 %, respectively. In the R0 patients’ survival, there was not a significant difference between bilioenteric anastomosis and hepatoenteric anastomosis (P = 0.714).
Conclusions
Combined caudate lobe and high hilar resection (CCHR) is technically safe and oncologically justifiable and could be adopted with a high cure rate as a one-stage resection procedure for most patients with Bismuth type IV HC whose total bilirubin level is less than 20 mg/L and whose direct bilirubin is more than 60 % of total bilirubin.
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