Clinical Research of Hepatectomy Combined with Vascular Resection and Reconstruction in Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GUANXiao-qing , GUShu-cheng , WUJi ,  ZHENGXiang-xin , ZHANGXu-xu , YUANMu , WUJian-qiang , CHENYan , WUJi-sheng

Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical College/Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, Suqian 223800, jiangsu Province, China;

Corresponding author：

ZHENGXiang-xin, Email: zhengxiangxin_dr@163.com

Keywords：

Hilar cholangiocarcinoma; Hepatectomy; Vascular resection; Vascular reconstruction; Radical operation

DOI：

10.7507/1007-9424.20150016

Video：

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Objective To explore the clinical significance of hepatectomy combined with vascular reconstruction in hilar cholangiocarcinoma with vascular invasion. Methods The clinical data of 62 cases of hilar cholangiocarcinoma with vascular invasion in Suqian People's Hospital of Nanjing Drum-Tower Hospital Group from January 2006 to January 2014 were analyzed retrospectively. All cases were divided into two groups according to assessment of surgical trauma tolerance, nutritional status, and family's wishes. Thirty-three cases underwent hilar cholangiocarcinoma radical operation and hepatic artery combined with portal vein resection and reconstruction (combined resection group), while 29 cases of hilar cholangiocarcinoma underwent palliative surgery for treating jaundice in synchronization (palliative operation group). Results The median survivals in combined resection group and palliative operation group was 26.3 and 9.6 months, respectively. The survival rates of 1-year, 2-year, and 3-year between combined resection group and palliative operation group were 84.85% vs. 26.32%, 66.67% vs. 15.79%, and 42.42% vs. 0, respectively, there were significant differences between both groups in survival time and survival rate (t=4.470, P=0.000; χ²=28.338, 20.348, and 15.891, P=0.000). Among of 33 cases in combined resection group, postoperative complications occurred in 9 cases, the rate of complications was 27.27% and the mortality rate in perioperative period was 3.03%; while postoperative complications in palliative operation group occurred in 5 cases, the rate of complications was 17.24%, no case died in the perioperative period. There were no significant difference between both groups in the rate of postoperative complications and the mortality rate in perioperative period (χ²=0.888, P=0.346; χ²=0.893, P=0.345). Conclusions Hepatectomy combined with vascular resection and reconstruction can significantly improve the radical resection (R0) rate of HCCA, and greatly increase the 1-year, 2-year, and 3-year survival rates of patients. Furthermore, complications can be controlled, and the mortality rate in perioperative period does not increase.

Citation： GUANXiao-qing, GUShu-cheng, WUJi, ZHENGXiang-xin, ZHANGXu-xu, YUANMu, WUJian-qiang, CHENYan, WUJi-sheng. Clinical Research of Hepatectomy Combined with Vascular Resection and Reconstruction in Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(1): 64-69. doi: 10.7507/1007-9424.20150016 Copy

1.	Jang JY, Kim SW, Park DJ, et al. Actual long-term outcome of extrahepaticbile cancer after surgical resection. Ann Surg, 2005, 241(1):77-84.
2.	Deoliveira ML, Schulick RD, Nimura A, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4):1363-1371.
3.	许戈良, 马金良, 李建生, 等.肝门胆管癌切除的处理体会.外科理论与实践, 2003, 8(2):118-120.
4.	荚卫东, 许戈良, 刘文斌.肝门上入路切除肝门部胆管癌的手术技巧.国际外科学杂志, 2011, 38(5):356-358.
5.	许戈良, 胡何节, 马金良, 等.肝门上入路法切除高位胆管癌.临床外科杂志, 2006, 14(2):90-92.
6.	杜成友, 刘强.肝门胆管癌的术式选择.中国普外基础与临床杂志, 2014, 21(3):265-267.
7.	姜洪池, 孙备, 陆朝阳, 等. 54例肝门部胆管癌手术切除技术体会.中华外科杂志, 2006, 44(7):441-444.
8.	梁力建, 赖佳明, 李绍强, 等. 103例肝门部胆管癌的外科手术切除治疗.中华外科杂志, 2006, 44(13):882-884.
9.	刘付宝, 耿小平, 赵红川, 等.根治性切除治疗肝门部胆管癌.肝胆外科杂志, 2011, 19(4):267-270.
10.	Stroszczynski C, Hunerbein M. Malignant biliary obstruction:value of imaging findings. Abdom Imaging, 2005, 30(3):314-323.
11.	Vladov N, Lukanova TS, Takorov I, et al. Single centre experience with surgical treatment of hilar cholangiocarcinoma. Chirurgia (Bucur), 2013, 108(3):299-303.
12.	彭沙沙, 黄汉飞, 段键, 等.联合肝叶切除治疗肝门部胆管癌的疗效分析.中国癌症杂志, 24(6):451-456.
13.	邹声泉.重视肝门部胆管癌的手术治疗.中国普外基础与临床杂志, 2014, 21(3):257-259.
14.	孙诚谊, 江建新.肝门部胆管癌的外科治疗.世界华人消化杂志, 2011, 19(8):771-776.
15.	成雨, 陈鸿强, 戴剑, 等.肝切除、肝门-空肠吻合治疗BismuthⅣ肝门部胆管癌.中华普通外科杂志, 2010, 25(4):269-272.
16.	Ebata T, Nagino M, Kamiya J, et al. Hepatectomywith portal vein resection for hilar cholangiocarcinoma:audit of 52 consecutive cases. Ann Surg, 2003, 238(5):720-727.
17.	Munoz L, Roayaie S, MamanD, et al. Hilar cholangiocarcinoma involving the portal vein bifurcation:long-term results after resecton. J Hepatobiliary Pancreat Surg, 2002, 9(2):237-241.
18.	Miyazaki M, Ito H, Kmiura F, et al. Hilar cholangiocarcinoma. Nippon Geka Gakkai Zasshi, 2005, 106(4):291-296.
19.	Franco D, Usatoff V. Surgery for cholangiocarcinorna. Hepatogastroenterology, 2001, 48(37):53-55.
20.	唐文皓, 唐健雄, 袁祖荣.肝门部胆管癌的治疗现状.国际外科学杂志, 2012, 39(5):296-298.
21.	刘占兵, 杨尹默.目前胆道外科应重视的几个问题.国际外科学杂志, 2012, 39(5):298-301.
22.	李汉贤, 唐超明, 秦春宏, 等.联合肝叶和肝门血管切除治疗肝门胆管癌.中国普通外科杂志, 2004, 13(7):485-488.
23.	韩风, 周进学, 庞春, 等.联合肝动脉切除在肝门部胆管癌根治术中的应用.中国现代医学杂志, 2007, 17(11):1395-1397.
24.	蔡守旺, 曾建平, 梁雨荣, 等.肝门部胆管癌根治性切除术中血管切除和重建15例报告.腹部外科, 2010, 23(2):77-79.
25.	李文岗, 李滨, 黄志强, 等.失去肝动脉血液供应后大鼠肝门部胆管周围血管丛变化的三维构像研究.中华器官移植杂志, 2006, 27(3):149-151.
26.	曾永毅, 郑树国, 别平, 等.合并肝动脉切除重建的肝门部胆管癌根治术.中国实用外科杂志, 2007, 27(5):381-384.
27.	陈志国, 雷霆, 魏海梁, 等.肝门部胆管癌根治术肝动脉重建7例体会.肝胆胰外科杂志, 2010, 22(4):316-318.
28.	管小青, 陈焰, 顾书成, 等.扩大胰十二指肠切除术中联合肝动脉、肝固有固有动脉与髂内静脉切除重建应用的可行性研究.中国普外基础与临床杂志, 2012, 19(2):181-187.
29.	耿小平, 刘付宝.联合肝叶扩大切除治疗肝门胆管癌.肝胆外科杂志, 2008, 16(2):144-145.
30.	Kondo S, Hayakawa N, Nimura Y, et al. Extensive surgery for carcinoma of gallbladder. Br J Surg, 2002, 89(2):179-184.
31.	Gerhards MF, Van Gulik TM, DeW it LT, et al. Evaluation of morbidity andmortality after resection forhilar cholangiocarcinoma-a single center experience. Surgery, 2000, 127(4):395-404.
32.	De Santibafies E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure:a novel method. World J Surg, 2012, 36(1):125-128.
33.	李风, 周光文. 2 280例肝门胆管癌的荟萃分析.中华肝胆外科杂志, 2013, 19(3):171-176.

1. Jang JY, Kim SW, Park DJ, et al. Actual long-term outcome of extrahepaticbile cancer after surgical resection. Ann Surg, 2005, 241(1):77-84.
2. Deoliveira ML, Schulick RD, Nimura A, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4):1363-1371.
3. 许戈良, 马金良, 李建生, 等.肝门胆管癌切除的处理体会.外科理论与实践, 2003, 8(2):118-120.
4. 荚卫东, 许戈良, 刘文斌.肝门上入路切除肝门部胆管癌的手术技巧.国际外科学杂志, 2011, 38(5):356-358.
5. 许戈良, 胡何节, 马金良, 等.肝门上入路法切除高位胆管癌.临床外科杂志, 2006, 14(2):90-92.
6. 杜成友, 刘强.肝门胆管癌的术式选择.中国普外基础与临床杂志, 2014, 21(3):265-267.
7. 姜洪池, 孙备, 陆朝阳, 等. 54例肝门部胆管癌手术切除技术体会.中华外科杂志, 2006, 44(7):441-444.
8. 梁力建, 赖佳明, 李绍强, 等. 103例肝门部胆管癌的外科手术切除治疗.中华外科杂志, 2006, 44(13):882-884.
9. 刘付宝, 耿小平, 赵红川, 等.根治性切除治疗肝门部胆管癌.肝胆外科杂志, 2011, 19(4):267-270.
10. Stroszczynski C, Hunerbein M. Malignant biliary obstruction:value of imaging findings. Abdom Imaging, 2005, 30(3):314-323.
11. Vladov N, Lukanova TS, Takorov I, et al. Single centre experience with surgical treatment of hilar cholangiocarcinoma. Chirurgia (Bucur), 2013, 108(3):299-303.
12. 彭沙沙, 黄汉飞, 段键, 等.联合肝叶切除治疗肝门部胆管癌的疗效分析.中国癌症杂志, 24(6):451-456.
13. 邹声泉.重视肝门部胆管癌的手术治疗.中国普外基础与临床杂志, 2014, 21(3):257-259.
14. 孙诚谊, 江建新.肝门部胆管癌的外科治疗.世界华人消化杂志, 2011, 19(8):771-776.
15. 成雨, 陈鸿强, 戴剑, 等.肝切除、肝门-空肠吻合治疗BismuthⅣ肝门部胆管癌.中华普通外科杂志, 2010, 25(4):269-272.
16. Ebata T, Nagino M, Kamiya J, et al. Hepatectomywith portal vein resection for hilar cholangiocarcinoma:audit of 52 consecutive cases. Ann Surg, 2003, 238(5):720-727.
17. Munoz L, Roayaie S, MamanD, et al. Hilar cholangiocarcinoma involving the portal vein bifurcation:long-term results after resecton. J Hepatobiliary Pancreat Surg, 2002, 9(2):237-241.
18. Miyazaki M, Ito H, Kmiura F, et al. Hilar cholangiocarcinoma. Nippon Geka Gakkai Zasshi, 2005, 106(4):291-296.
19. Franco D, Usatoff V. Surgery for cholangiocarcinorna. Hepatogastroenterology, 2001, 48(37):53-55.
20. 唐文皓, 唐健雄, 袁祖荣.肝门部胆管癌的治疗现状.国际外科学杂志, 2012, 39(5):296-298.
21. 刘占兵, 杨尹默.目前胆道外科应重视的几个问题.国际外科学杂志, 2012, 39(5):298-301.
22. 李汉贤, 唐超明, 秦春宏, 等.联合肝叶和肝门血管切除治疗肝门胆管癌.中国普通外科杂志, 2004, 13(7):485-488.
23. 韩风, 周进学, 庞春, 等.联合肝动脉切除在肝门部胆管癌根治术中的应用.中国现代医学杂志, 2007, 17(11):1395-1397.
24. 蔡守旺, 曾建平, 梁雨荣, 等.肝门部胆管癌根治性切除术中血管切除和重建15例报告.腹部外科, 2010, 23(2):77-79.
25. 李文岗, 李滨, 黄志强, 等.失去肝动脉血液供应后大鼠肝门部胆管周围血管丛变化的三维构像研究.中华器官移植杂志, 2006, 27(3):149-151.
26. 曾永毅, 郑树国, 别平, 等.合并肝动脉切除重建的肝门部胆管癌根治术.中国实用外科杂志, 2007, 27(5):381-384.
27. 陈志国, 雷霆, 魏海梁, 等.肝门部胆管癌根治术肝动脉重建7例体会.肝胆胰外科杂志, 2010, 22(4):316-318.
28. 管小青, 陈焰, 顾书成, 等.扩大胰十二指肠切除术中联合肝动脉、肝固有固有动脉与髂内静脉切除重建应用的可行性研究.中国普外基础与临床杂志, 2012, 19(2):181-187.
29. 耿小平, 刘付宝.联合肝叶扩大切除治疗肝门胆管癌.肝胆外科杂志, 2008, 16(2):144-145.
30. Kondo S, Hayakawa N, Nimura Y, et al. Extensive surgery for carcinoma of gallbladder. Br J Surg, 2002, 89(2):179-184.
31. Gerhards MF, Van Gulik TM, DeW it LT, et al. Evaluation of morbidity andmortality after resection forhilar cholangiocarcinoma-a single center experience. Surgery, 2000, 127(4):395-404.
32. De Santibafies E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure:a novel method. World J Surg, 2012, 36(1):125-128.
33. 李风, 周光文. 2 280例肝门胆管癌的荟萃分析.中华肝胆外科杂志, 2013, 19(3):171-176.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Research of Hepatectomy Combined with Vascular Resection and Reconstruction in Hilar Cholangiocarcinoma

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