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Surgical Strategies for the Treatment of Bismuth Type I and II Hilar Cholangiocarcinoma: Bile Duct Resection with or Without Hepatectomy?

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of hepatic resection in the treatment of type I and II hilar cholangiocarcinoma (HCCA) remains controversial. In the present study, we aimed to identify whether hepatic resection was necessary for type I and II HCCA.

Methods

A total of 23 patients classified as type I and II HCCA undergoing surgical resection were included in this study. The patients were divided into two groups: bile duct resection (BDR) group (n = 15) and hepatic resection (HR) group (n = 8). Systematic review and meta-analysis were performed to compare the R0 resection and long-term survival between BDR and HR for Bismuth type I and II HCCA. A total of 7 studies with 260 cases were included in this meta-analysis.

Results

In our cohort, the R0 resection rate was 73.3% in BDR group and 87.5% in HR group. The HR group had a higher number of postoperative complications than the BDR group (P = 0.002). There was no difference in long-term survival (P = 0.544) and recurrence (P = 0.846) between BDR and HR in Bismuth type I and II HCCA. The meta-analysis showed that HR was associated with better R0 resection rate (RR 4.45, 95% CI 2.34–8.48) and overall survival (HR 2.15, 95% CI 1.34–3.44) compared with BDR group. There was no publication bias and undue influence of any single study.

Conclusions

The meta-analysis showed that HR was associated with better R0 resection rate and overall survival compared with BDR for type I and II HCCA patients. More aggressive surgical strategies should be increasingly considered for the treatment of type I and II HCCA patients.

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References

  1. Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology. 2013;145(6):1215–1229.

    Article  CAS  Google Scholar 

  2. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis An unusual tumor with distinctive clinical and pathological features. Am J Med. 1965;38:241–256.

    Article  CAS  Google Scholar 

  3. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstetr. 1975;140(2):170–178.

    CAS  Google Scholar 

  4. Ito F, Cho CS, Rikkers LF, Weber SM. Hilar cholangiocarcinoma: current management. Ann Surg. 2009;250(2):210–218.

    Article  Google Scholar 

  5. Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepato-biliary-pancreatic Sci. 2010;17(4):449–454.

    Article  Google Scholar 

  6. Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis. 2015;30(2):159-171.

    Article  Google Scholar 

  7. Launois B, Terblanche J, Lakehal M, et al. Proximal bile duct cancer: high resectability rate and 5-year survival. Ann Surg. 1999;230(2):266–275.

    Article  CAS  Google Scholar 

  8. Otani K, Chijiiwa K, Kai M, Ohuchida J, Nagano M, Kondo K. Role of hilar resection in the treatment of hilar cholangiocarcinoma. Hepato-gastroenterology. 59(115):696–700.

    PubMed  Google Scholar 

  9. Ikeyama T, Nagino M, Oda K, Ebata T, Nishio H, Nimura Y. Surgical approach to Bismuth type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg. 2007;246(6):1052–1057.

    Article  Google Scholar 

  10. Capussotti L, Muratore A, Polastri R, Ferrero A, Massucco P. Liver resection for hilar cholangiocarcinoma: in-hospital mortality and longterm survival. J Am College Surg. 2002;195(5):641–647.

    Article  Google Scholar 

  11. Lim JH, Choi GH, Choi SH, Kim KS, Choi JS, Lee WJ. Liver resection for Bismuth type I and type II hilar cholangiocarcinoma. World J Surg. 2013;37(4):829–837.

    Article  Google Scholar 

  12. Xiong J, Nunes QM, Huang W, et al. Major hepatectomy in Bismuth types I and II hilar cholangiocarcinoma. J Surg Res. 2015;194(1):194–201.

    Article  Google Scholar 

  13. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–196.

    Article  Google Scholar 

  14. Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma. Ann. Surg. 1999;230(6):808–818; discussion 819.

  15. Song SC, Choi DW, Kow AW, et al. Surgical outcomes of 230 resected hilar cholangiocarcinoma in a single centre. ANZ J Surg. 2013;83(4):268–274.

    Article  Google Scholar 

  16. Boerma EJ. Research into the results of resection of hilar bile duct cancer. Surgery. 1990;108(3):572–580.

    CAS  PubMed  Google Scholar 

  17. Lee SG, Lee YJ, Park KM, Hwang S, Min PC. One hundred and eleven liver resections for hilar bile duct cancer. J Hepato-biliary-pancreatic Surg. 2000;7(2):135–141.

    Article  CAS  Google Scholar 

  18. Neuhaus P, Thelen A. Radical surgery for right-sided Klatskin tumor. HPB Off J Int Hepato Pancreato Biliary Assoc. 2008;10(3):171–173.

    Article  CAS  Google Scholar 

  19. Lee SG, Song GW, Hwang S, et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepato-biliary-pancreatic Sci. 2010;17(4):476–489.

    Article  Google Scholar 

  20. Okazaki Y, Horimi T, Kotaka M, Morita S, Takasaki M. Study of the intrahepatic surgical margin of hilar bile duct carcinoma. Hepato-gastroenterology. 2002;49(45):625–627.

    PubMed  Google Scholar 

  21. Endo I, House MG, Klimstra DS, et al. Clinical significance of intraoperative bile duct margin assessment for hilar cholangiocarcinoma. Ann Surg Oncol. 2008;15(8):2104–2112.

    Article  Google Scholar 

  22. Shinohara K, Ebata T, Shimoyama Y, et al. A study on radial margin status in resected perihilar cholangiocarcinoma. Ann Surg. 2019. https://doi.org/10.1097/SLA.0000000000003305.

    Article  PubMed  Google Scholar 

  23. Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227(3):405–411.

    Article  CAS  Google Scholar 

  24. Hayashi S, Miyazaki M, Kondo Y, Nakajima N. Invasive growth patterns of hepatic hilar ductal carcinoma A histologic analysis of 18 surgical cases. Cancer. 15 1994;73(12):2922–2929.

  25. Sugiura T, Okamura Y, Ito T, et al. Left hepatectomy with combined resection and reconstruction of right hepatic artery for Bismuth type I and II perihilar cholangiocarcinoma. World J Surg. 2019;43(3):894–901.

    Article  Google Scholar 

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Acknowledgments

This study was supported by the National Science Foundation of China (NSFC) (81700572, 81670570), Natural Science Foundation of Jiangsu Province, China (BK20171077), and Key Research and Development Program of Jiangsu Province (BE2016789).

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Author notes

  1. Rui Xiang Chen and Chang Xian Li have contributed equally as joint first authors.

Authors and Affiliations

  1. Hepatobiliary Center, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

    Rui Xiang Chen MBBS, Chang Xian Li PhD, Cheng Huan Luo MBBS, Hui Zhang MBBS, Tao Zhou MBBS, Xiao Feng Wu PhD, Xue Hao Wang PhD & Xiang Cheng Li PhD

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  1. Rui Xiang Chen MBBS
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  2. Chang Xian Li PhD
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  3. Cheng Huan Luo MBBS
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  4. Hui Zhang MBBS
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Correspondence to Chang Xian Li PhD or Xiang Cheng Li PhD.

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Chen, R.X., Li, C.X., Luo, C.H. et al. Surgical Strategies for the Treatment of Bismuth Type I and II Hilar Cholangiocarcinoma: Bile Duct Resection with or Without Hepatectomy?. Ann Surg Oncol 27, 3374–3382 (2020). https://doi.org/10.1245/s10434-020-08453-2

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  • DOI: https://doi.org/10.1245/s10434-020-08453-2

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