Detailed Abstract
[BP Symposium 5 - Recent Progress in Locally Advanced Hilar Cholangiocarcinoma]
[BP SY 5-3] Benefits of Hilar En Bloc Resection for Hilar Cholangiocarcinoma : From Right to Left (with video)
Caide Lu
Medical School of Ningbo University, China
Background
Hilar en bloc resection has been advocated as a standard procedure for treatment of right-sided hilar cholangiocarcinoma (HC) with vascular involvement. However, the safety, feasibility and survival outcomes of this procedure, as well as its technical problems from right to left, remain concerns.
Methods
A total of 196 patients with HC received surgery in the Department of Hepatopancreatobiliary Surgery ( HPB) of the Lihuili Eastern Hospital of Ningbo from 2005 to 2017. Among the 196 patients, 139 patients underwent R0 and R1 resection and medical records of 56 consecutive patients who had received HC resection with vascular resection and reconstruction were retrieved from a prospectively maintained data base. The clinicopathological features, surgical procedures and survival outcomes were compared between patients with hilar en-bloc resection from 2013 to 2017(Group A, n=36) and those with conventional techniques from 2005 to 2012(Group B, n=20).
Results
Hilar en block resection could be performed in the following hepatectomy procedures: right-sided, left-sided or central hepatectomies. Clinical characteristics were compared between Group A and B, with more patients classified as Bismuth-Corlette IV in Group A. (Tables 1 to 3). The operative time was 494±115 minutes for Group A, which was significantly longer than that of Group B. There were more patients underwent resection with more than one organ and had more lymph nodes (LNs) harvested in Group A than patients in Group B (P< 0.05). More patients in Group A had simultaneous resection of PV and HA (P= 0.053). The R0 resection rate was 88.9% (32/36) in Group A in comparison to that of 65% in Group B (13/20) (P= 0.031; Table 3). Overall complications classified as Clavier’s III were significantly higher in Group B than in Group A (P= 0.022; Table 4). The difference for operation mortality in both groups had not reached the statistical level. The 1-, 3-, and 5-year survival rates of patients after hilar en-bloc resection in Group A were 82.4%, 48.4%, and 38.7%, respectively, which was significantly higher than that of patients in Group B after conventional resection. In the latter group, 1-, 3-, and 5-year survival rates were 64.7%, 29.4%, and 23.5%, respectively (P = 0.044).
Conclusion
Hilar en-bloc resection in principle could be performed safely not only in right-sided hepatectomy but also in left-sided and central hepatectomies. Benefits of hilar en-block resection has been demonstrated by higher rate of R0 resection, more LNs harvested and superior survival outcomes of patients with this novel technique in comparison with those who underwent conventional resection of HC.
Hilar en bloc resection has been advocated as a standard procedure for treatment of right-sided hilar cholangiocarcinoma (HC) with vascular involvement. However, the safety, feasibility and survival outcomes of this procedure, as well as its technical problems from right to left, remain concerns.
Methods
A total of 196 patients with HC received surgery in the Department of Hepatopancreatobiliary Surgery ( HPB) of the Lihuili Eastern Hospital of Ningbo from 2005 to 2017. Among the 196 patients, 139 patients underwent R0 and R1 resection and medical records of 56 consecutive patients who had received HC resection with vascular resection and reconstruction were retrieved from a prospectively maintained data base. The clinicopathological features, surgical procedures and survival outcomes were compared between patients with hilar en-bloc resection from 2013 to 2017(Group A, n=36) and those with conventional techniques from 2005 to 2012(Group B, n=20).
Results
Hilar en block resection could be performed in the following hepatectomy procedures: right-sided, left-sided or central hepatectomies. Clinical characteristics were compared between Group A and B, with more patients classified as Bismuth-Corlette IV in Group A. (Tables 1 to 3). The operative time was 494±115 minutes for Group A, which was significantly longer than that of Group B. There were more patients underwent resection with more than one organ and had more lymph nodes (LNs) harvested in Group A than patients in Group B (P< 0.05). More patients in Group A had simultaneous resection of PV and HA (P= 0.053). The R0 resection rate was 88.9% (32/36) in Group A in comparison to that of 65% in Group B (13/20) (P= 0.031; Table 3). Overall complications classified as Clavier’s III were significantly higher in Group B than in Group A (P= 0.022; Table 4). The difference for operation mortality in both groups had not reached the statistical level. The 1-, 3-, and 5-year survival rates of patients after hilar en-bloc resection in Group A were 82.4%, 48.4%, and 38.7%, respectively, which was significantly higher than that of patients in Group B after conventional resection. In the latter group, 1-, 3-, and 5-year survival rates were 64.7%, 29.4%, and 23.5%, respectively (P = 0.044).
Conclusion
Hilar en-bloc resection in principle could be performed safely not only in right-sided hepatectomy but also in left-sided and central hepatectomies. Benefits of hilar en-block resection has been demonstrated by higher rate of R0 resection, more LNs harvested and superior survival outcomes of patients with this novel technique in comparison with those who underwent conventional resection of HC.
SESSION
BP Symposium 5
Room A 3/31/2018 5:10 PM - 5:30 PM