Surgical Treatment and Influence Factors of Prognosis in 189 Cases of Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SUNXue-jun , ZHENGJian-bao , HESai

Department of General Surgery, The First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China;

Corresponding author：

SUNXue-jun, Email: sunxy@mail.xjtu.edu.cn

Keywords：

Hilar cholangiocarcinoma; Surgery; Prognosis; Influence factor; Cox proportional hazard model

DOI：

10.7507/1007-9424.20140067

Video：

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Objective To summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. Methods Clinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. Results Of 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. Conclusions Radical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.

Citation： SUNXue-jun, ZHENGJian-bao, HESai. Surgical Treatment and Influence Factors of Prognosis in 189 Cases of Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 273-277. doi: 10.7507/1007-9424.20140067 Copy

1.	Klatskin G. Adenocarcinoma of the hepatic duct atits bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features[J]. Am J Med, 1965, 38:241-256.
2.	Saxena A, Chua TC, Chu FC, et al. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma:a critical analysis of recurrence and survival[J]. Am J Surg, 2011, 202(3):310-320.
3.	唐文皓, 唐健雄, 袁祖荣.肝门部胆管癌的治疗现状[J].国际外科学杂志, 2012, 39(5):296-298.
4.	Zhimin G, Noor H, Jian-Bo Z, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma-a review[J]. Med Sci Monit, 2013, 19:648-656.
5.	Gavrilovici V, Grecu F, Seripcariu V, et al. Classification and staging systems for hilar cholangio-carcinoma (Klatskin tumors):clinical application and practical relevance[J]. Rev Med Chir Soc Med Nat Iasi, 2011, 115(2):412-417.
6.	Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, et al. Risk factors and classifications of hilar cholangiocarcinoma[J]. World J Gastrointest Oncol, 2013, 5(7):132-138.
7.	何效东, 董家鸿, 赵晓雷, 等.肝门部胆管癌的诊断与外科治疗[J].中华肝胆外科杂志, 2008, 14(8):582-584.
8.	Marubashi S, Gotoh K, Takahashi H, et al. Prediction of the postoperative prognosis of intrahepatic cholangiocarcinoma (ICC):importance of preoperatively-determined anatomic invasion level and number of tumors[J]. Dig Dis Sci, 2013, 12.[Epub ahead of print].
9.	黄志强.肝门部胆管癌外科治疗的现状与我见[J].中国实用外科杂志, 2007, 27(5):341-346.
10.	张永杰.肝门部胆管癌外科治疗的术式选择及评价[J].中国实用外科杂志, 2007, 27(5):358-361.
11.	王越, 侴伟平, 葛春林.肝门部胆管癌患者生存预测模型的分析[J].中国普外基础与临床杂志, 2011, 18(6):590-594.
12.	Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioper-ative and long-term outcome after surgical treatment of hilar cholang-iocarcinoma:results of an Italian multicenter analysis of 440 patients[J]. Arch Surg, 2012, 147(1):26-34.
13.	Lim JH, Choi GH, Choi SH, et al. Liver resection for Bismuth typeⅠand typeⅡhilar cholangiocarcinoma[J]. World J Surg, 2013, 37(4):829-837.
14.	Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4:prognostic factors and longterm outcomes[J]. J Am Coll Surg, 2007, 204(2):250-260.
15.	Izbicki JR, Tsui TY, Bohn BA, et al. Surgical strategies in patients with advanced hilar cholangiocarcinoma (Klatskin tumor)[J]. J Gastrointest Surg, 2013, 17(3):581-585.
16.	Rosen CB, Darwish Murad S, Heimbach JK, et al. Neoadjuvant therapy and liver transplantation for hilar cholangiocarcinoma:is pretreatment pathological confirmation of diagnosis necessary?[J]. J Am Coll Surg, 2012, 215(1):31-38.
17.	Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma[J]. World J Gastroenterol, 2013, 19(48):9209-9215.
18.	Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma[J]. Transpl Int, 2010, 23(7):692-697.
19.	孙学军, 石景森, 何平.影响胆管癌切除术后的预后因素分析[J].中国普外基础与临床杂志, 2006, 13(1):85-88.
20.	Puhalla H, Gruenberger T, Pokorny H, et al. Resection of hilar cholangiocarcinomas:pivotal prognostic factors and impact of tumor sclerosis[J]. World J Surg, 2003, 27(6):680-684.
21.	何平, 石景森, 陈武科, 等.应用Cox模型分析影响胆管癌切除术后的预后因素[J].中华肝胆外科杂志, 2002, 8(4):219-221.
22.	Cannon RM, Brock G, Buell JF. Surgical resection for hilar cholangiocarcinoma:experience improves resectability[J]. HPB (Oxford), 2012, 14(2):142-149.
23.	Serrablo A, Tejedor L. Outcome of surgical resection in Klatskin tumors[J]. World J Gastrointest Oncol, 2013, 5(7):147-158.
24.	Guglielmi A, Ruzzenente A, Campagnaro T, et al. Prognostic significance of lymph node ratio after resection of peri-hilar cholangiocarcinoma[J]. HPB (Oxford), 2011, 13(4):240-245.
25.	Nagino M. Perihilar cholangiocarcinoma:a surgeon's viewpoint on current topics[J]. J Gastroenterol, 2012, 47(11):1165-1176.

1. Klatskin G. Adenocarcinoma of the hepatic duct atits bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features[J]. Am J Med, 1965, 38:241-256.
2. Saxena A, Chua TC, Chu FC, et al. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma:a critical analysis of recurrence and survival[J]. Am J Surg, 2011, 202(3):310-320.
3. 唐文皓, 唐健雄, 袁祖荣.肝门部胆管癌的治疗现状[J].国际外科学杂志, 2012, 39(5):296-298.
4. Zhimin G, Noor H, Jian-Bo Z, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma-a review[J]. Med Sci Monit, 2013, 19:648-656.
5. Gavrilovici V, Grecu F, Seripcariu V, et al. Classification and staging systems for hilar cholangio-carcinoma (Klatskin tumors):clinical application and practical relevance[J]. Rev Med Chir Soc Med Nat Iasi, 2011, 115(2):412-417.
6. Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, et al. Risk factors and classifications of hilar cholangiocarcinoma[J]. World J Gastrointest Oncol, 2013, 5(7):132-138.
7. 何效东, 董家鸿, 赵晓雷, 等.肝门部胆管癌的诊断与外科治疗[J].中华肝胆外科杂志, 2008, 14(8):582-584.
8. Marubashi S, Gotoh K, Takahashi H, et al. Prediction of the postoperative prognosis of intrahepatic cholangiocarcinoma (ICC):importance of preoperatively-determined anatomic invasion level and number of tumors[J]. Dig Dis Sci, 2013, 12.[Epub ahead of print].
9. 黄志强.肝门部胆管癌外科治疗的现状与我见[J].中国实用外科杂志, 2007, 27(5):341-346.
10. 张永杰.肝门部胆管癌外科治疗的术式选择及评价[J].中国实用外科杂志, 2007, 27(5):358-361.
11. 王越, 侴伟平, 葛春林.肝门部胆管癌患者生存预测模型的分析[J].中国普外基础与临床杂志, 2011, 18(6):590-594.
12. Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioper-ative and long-term outcome after surgical treatment of hilar cholang-iocarcinoma:results of an Italian multicenter analysis of 440 patients[J]. Arch Surg, 2012, 147(1):26-34.
13. Lim JH, Choi GH, Choi SH, et al. Liver resection for Bismuth typeⅠand typeⅡhilar cholangiocarcinoma[J]. World J Surg, 2013, 37(4):829-837.
14. Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4:prognostic factors and longterm outcomes[J]. J Am Coll Surg, 2007, 204(2):250-260.
15. Izbicki JR, Tsui TY, Bohn BA, et al. Surgical strategies in patients with advanced hilar cholangiocarcinoma (Klatskin tumor)[J]. J Gastrointest Surg, 2013, 17(3):581-585.
16. Rosen CB, Darwish Murad S, Heimbach JK, et al. Neoadjuvant therapy and liver transplantation for hilar cholangiocarcinoma:is pretreatment pathological confirmation of diagnosis necessary?[J]. J Am Coll Surg, 2012, 215(1):31-38.
17. Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma[J]. World J Gastroenterol, 2013, 19(48):9209-9215.
18. Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma[J]. Transpl Int, 2010, 23(7):692-697.
19. 孙学军, 石景森, 何平.影响胆管癌切除术后的预后因素分析[J].中国普外基础与临床杂志, 2006, 13(1):85-88.
20. Puhalla H, Gruenberger T, Pokorny H, et al. Resection of hilar cholangiocarcinomas:pivotal prognostic factors and impact of tumor sclerosis[J]. World J Surg, 2003, 27(6):680-684.
21. 何平, 石景森, 陈武科, 等.应用Cox模型分析影响胆管癌切除术后的预后因素[J].中华肝胆外科杂志, 2002, 8(4):219-221.
22. Cannon RM, Brock G, Buell JF. Surgical resection for hilar cholangiocarcinoma:experience improves resectability[J]. HPB (Oxford), 2012, 14(2):142-149.
23. Serrablo A, Tejedor L. Outcome of surgical resection in Klatskin tumors[J]. World J Gastrointest Oncol, 2013, 5(7):147-158.
24. Guglielmi A, Ruzzenente A, Campagnaro T, et al. Prognostic significance of lymph node ratio after resection of peri-hilar cholangiocarcinoma[J]. HPB (Oxford), 2011, 13(4):240-245.
25. Nagino M. Perihilar cholangiocarcinoma:a surgeon's viewpoint on current topics[J]. J Gastroenterol, 2012, 47(11):1165-1176.

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Surgical Treatment and Influence Factors of Prognosis in 189 Cases of Hilar Cholangiocarcinoma

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