Treatment Experience of Type Ⅳ Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Chun ,  CHEN Zheyu , ZENG Yong , YAN LUuml

Department of Hepatobiliary and Pancreatic Surgery， West China Hospital， Sichuan University， Chengdu 610041， China;

Corresponding author：

CHEN Zheyu, Email: chenzheyu71@yahoo.com.cn

Keywords：

Ⅳ hilar cholangiocarcinoma; Treatment; Roux-en-Y jejunojejunostomy; Percutaneous transhepatic cholangial drainage; Portal vein embolization

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Objective 　To explore primary surgical treatment experience of typeⅣ hilar cholangiocarcinoma.
Methods 　From April 2008 to April 2011，20 patients with type Ⅳ hilar cholangiocarcinoma were enrolled into the same surgical group in Department of Hepatobiliary and Pancreatic Surgery of West China Hospital of Sichuan University.The intra- and post-operative results were analyzed.
Results 　The total resection rate was 75%，which was consisted of 10 cases of radical excision and 5 cases of non-radical excision.Seven patients received left hepatic trisegmentectomy and caudate lobe resection including anterior and posterior right hepatic duct reconstruction，hepatojejunostomy，and Roux-en-Y jejunojejunostomy.Six patients received enlarged left hepatic trisegmentectomy and caudate lobe resection including left intrahepatic and extrahepatic duct reconstruction，hepatojejunostomy，and Roux-en-Y jejunojejunostomy. Two patients received quadrate lobe resection including two cholangioenterostomies after anterior and posterior right hepatic duct reconstruction，and left intrahepatic and extrahepatic duct reconstruction.After percutaneous transhepatic cholangial drainage （PTCD） and portal vein embolization （PVE），two patients with total bilirubins ＞
400 mmol/L received radical excision and non-radical excision，respectively.Three patients only received PTCD during operation due to wide liver and distant metastasis，and two patients received T tube drainage during operation and postoperative PTCD due to left and right portal vein involvement. All 15 patients who received lesion resection survived more than one year， whereas another five patients whose lesions can not been resec ted only survived from 3 to 6 months with the mean of 4.2 months.No death occurred during the perioperative period.
Conclusions 　For patients with type Ⅳ hilar cholangiocarcinoma， preoperative evaluation and tumor resection shall conducted so as to relieve obstruction of biliary tract，otherwise PTCD and PVE prior to the final lesion resection shall be performed.

Citation： WANG Chun,CHEN Zheyu,ZENG Yong,YAN LUuml,nan.. Treatment Experience of Type Ⅳ Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(1): 62-65. doi: Copy

1.	Friman S. Cholangiocarcinoma － current treatment options [J].Scand J Surg， 2011， 100(1)：30-34.
2.	黄志强. 肝门部胆管癌外科治疗 [J]. 临床外科杂志， 2006，14(2)：65-66．.
3.	Deoliveira ML， Schulick RD， Nimura Y， et al. New staging sys中国普外基础与临床杂志2012 年1 月第19 卷第1 期 Chin J Bases Clin General Surg, Vol. 19, No. 1, Jan. 2012 ? 65 ?tem and a registry for perihilar cholangiocarcinoma [J]. Hepatology，2011， 53(4)： 1363-1371.
4.	Agrawal S， Belghiti J. Oncologic resection for malignant tumors of the liver [J]. Ann Surg， 2011， 253(4)： 656-665.
5.	梁廷波．肝门部胆管癌外科治疗的几个问题 [J]．中国普外基础与临床杂志， 2011， 18(6)： 572-575．.
6.	耿小平．肝门部胆管癌外科治疗的争议与进展 [J]．中国普外基础与临床杂志， 2011， 18(6)： 569-571．.
7.	Zografos GN， Farfaras A， Zagouri F， et al. Cholangiocarcinoma:principles and current trends [J]. Hepatobiliary Pancreat Dis Int，2011， 10(1)： 10-20.
8.	黄志强．肝门部胆管癌外科治疗25 年的历程 [J]．中华消化外科杂志， 2010， 9(3)：161-164．.
9.	何强，梁力建．肝门部胆管癌外科治疗的若干问题 [J]．中国普外基础与临床杂志， 2009， 16(11)： 869-872．.
10.	Yi B， Xu AM， Lai EC， et al. Preoperative portal vein embolizati on for hilar cholangiocarcinoma— a comparative study [J]. Hepatogastroenterology，2010， 57(104)： 1341-1346.
11.	Kaiser GM， Sotiropoulos GC， Sgourakis G， et al. Surgical treatment of Klatskin tumor：liver resection versus transplantation [J]. Hepatogastroenterology， 2010， 57(104)： 1337-1340.
12.	易滨，姜小清．肝门部胆管癌的计划性肝切除 [J]．中国普外基础与临床杂志， 2011， 18(6)： 576-578．.
13.	周宁新，黄志强，张文智，等．402 例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [J]. 中华外科杂志， 2006，44 (23)： 1599-1603．.
14.	胡超华，胡若男，熊杰，等．肝门部胆管癌的手术治疗 [J]. 中国普外基础与临床杂志， 2009， 16(11)： 873-874．.
15.	van Gulik TM， Ruys AT， Busch OR， et al. Extent of liver resection for hilar cholangiocarcinoma (Klatskin tumor)： how much is enough? [J]. Dig Surg， 2011， 28(2)： 141-147.
16.	Akamatsu N， Sugawara Y， Hashimoto D. Surgical strategy for bile duct Cancer： Advances and current limitations [J]. World J Clin Oncol， 2011， 2(2)： 94-107.
17.	Hong JC， Jones CM， Duffy JP， et al. Comparative analysis of resection and liver transplantation for intrahepatic and hilar cholangiocarcinoma：a 24-year experience in a single center [J]. Arch Surg， 2011， 146(6)： 683-689.
18.	Patel SH， Kooby DA， Staley CA 3rd， et al. The prognostic importance of lymphovascular invasion in cholangiocarcinoma above the cystic duct： a new selection criterion for adjuvant therapy? [J]. HPB (Oxford) ， 2011， 13(9)： 605-611.
19.	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.
20.	杜希臣，金星林．Ⅲ， Ⅳ型肝门胆管癌切除术空肠前唇与肝面吻合应用价值研究 [J]．中国实用外科杂志， 2010， 30(4)： 307-308．.
21.	Sasaki R， Kondo T， Oda T， et al. Impact of three-dimensional analysis of multidetector row computed tomography cholangioportography in operative planning for hilar cholangiocarcinoma [J]. Am J Surg， 2011， 202(4)： 441-448.
22.	成雨，陈鸿强，戴剑，等肝切除、肝门-空肠吻合治疗Bismuth Ⅳ肝门部胆管癌 [J]．中华普通外科杂志， 2010， 25(4)： 269-272.
23.	Regimbeau JM， Fuks D， Le Treut YP， et al. Surgery for hilarcholangiocarcinoma：a multi-institutional update on practice and outcome by the AFC-HC study group [J]. J Gastrointest Surg，2011， 15(3)： 480-488.
24.	Hong YK， Choi SB， Lee KH， et al. The efficacy of portal vein embolization prior to right extended hemihepatectomy for hilar cholangiocellular carcinoma： a retrospective cohortstudy [J]. Eur J Surg Oncol， 2011， 37(3)： 237-244.
25.	王坚，王辉，王昊陆．提高肝门部胆管癌疗效的思考 [J]．中华消化外科杂志， 2010， 9(3)： 177-179．.
26.	Mihalache F， Tantau M， Diaconu B， et al. Survival and quality of life of cholangiocarcinoma patients：a prospective study over a 4 year period [J]. J Gastrointestin Liver Dis， 2010， 19(3)： 285-290.

1. Friman S. Cholangiocarcinoma － current treatment options [J].Scand J Surg， 2011， 100(1)：30-34.
2. 黄志强. 肝门部胆管癌外科治疗 [J]. 临床外科杂志， 2006，14(2)：65-66．.
3. Deoliveira ML， Schulick RD， Nimura Y， et al. New staging sys中国普外基础与临床杂志2012 年1 月第19 卷第1 期 Chin J Bases Clin General Surg, Vol. 19, No. 1, Jan. 2012 ? 65 ?tem and a registry for perihilar cholangiocarcinoma [J]. Hepatology，2011， 53(4)： 1363-1371.
4. Agrawal S， Belghiti J. Oncologic resection for malignant tumors of the liver [J]. Ann Surg， 2011， 253(4)： 656-665.
5. 梁廷波．肝门部胆管癌外科治疗的几个问题 [J]．中国普外基础与临床杂志， 2011， 18(6)： 572-575．.
6. 耿小平．肝门部胆管癌外科治疗的争议与进展 [J]．中国普外基础与临床杂志， 2011， 18(6)： 569-571．.
7. Zografos GN， Farfaras A， Zagouri F， et al. Cholangiocarcinoma:principles and current trends [J]. Hepatobiliary Pancreat Dis Int，2011， 10(1)： 10-20.
8. 黄志强．肝门部胆管癌外科治疗25 年的历程 [J]．中华消化外科杂志， 2010， 9(3)：161-164．.
9. 何强，梁力建．肝门部胆管癌外科治疗的若干问题 [J]．中国普外基础与临床杂志， 2009， 16(11)： 869-872．.
10. Yi B， Xu AM， Lai EC， et al. Preoperative portal vein embolizati on for hilar cholangiocarcinoma— a comparative study [J]. Hepatogastroenterology，2010， 57(104)： 1341-1346.
11. Kaiser GM， Sotiropoulos GC， Sgourakis G， et al. Surgical treatment of Klatskin tumor：liver resection versus transplantation [J]. Hepatogastroenterology， 2010， 57(104)： 1337-1340.
12. 易滨，姜小清．肝门部胆管癌的计划性肝切除 [J]．中国普外基础与临床杂志， 2011， 18(6)： 576-578．.
13. 周宁新，黄志强，张文智，等．402 例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [J]. 中华外科杂志， 2006，44 (23)： 1599-1603．.
14. 胡超华，胡若男，熊杰，等．肝门部胆管癌的手术治疗 [J]. 中国普外基础与临床杂志， 2009， 16(11)： 873-874．.
15. van Gulik TM， Ruys AT， Busch OR， et al. Extent of liver resection for hilar cholangiocarcinoma (Klatskin tumor)： how much is enough? [J]. Dig Surg， 2011， 28(2)： 141-147.
16. Akamatsu N， Sugawara Y， Hashimoto D. Surgical strategy for bile duct Cancer： Advances and current limitations [J]. World J Clin Oncol， 2011， 2(2)： 94-107.
17. Hong JC， Jones CM， Duffy JP， et al. Comparative analysis of resection and liver transplantation for intrahepatic and hilar cholangiocarcinoma：a 24-year experience in a single center [J]. Arch Surg， 2011， 146(6)： 683-689.
18. Patel SH， Kooby DA， Staley CA 3rd， et al. The prognostic importance of lymphovascular invasion in cholangiocarcinoma above the cystic duct： a new selection criterion for adjuvant therapy? [J]. HPB (Oxford) ， 2011， 13(9)： 605-611.
19. 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.
20. 杜希臣，金星林．Ⅲ， Ⅳ型肝门胆管癌切除术空肠前唇与肝面吻合应用价值研究 [J]．中国实用外科杂志， 2010， 30(4)： 307-308．.
21. Sasaki R， Kondo T， Oda T， et al. Impact of three-dimensional analysis of multidetector row computed tomography cholangioportography in operative planning for hilar cholangiocarcinoma [J]. Am J Surg， 2011， 202(4)： 441-448.
22. 成雨，陈鸿强，戴剑，等肝切除、肝门-空肠吻合治疗Bismuth Ⅳ肝门部胆管癌 [J]．中华普通外科杂志， 2010， 25(4)： 269-272.
23. Regimbeau JM， Fuks D， Le Treut YP， et al. Surgery for hilarcholangiocarcinoma：a multi-institutional update on practice and outcome by the AFC-HC study group [J]. J Gastrointest Surg，2011， 15(3)： 480-488.
24. Hong YK， Choi SB， Lee KH， et al. The efficacy of portal vein embolization prior to right extended hemihepatectomy for hilar cholangiocellular carcinoma： a retrospective cohortstudy [J]. Eur J Surg Oncol， 2011， 37(3)： 237-244.
25. 王坚，王辉，王昊陆．提高肝门部胆管癌疗效的思考 [J]．中华消化外科杂志， 2010， 9(3)： 177-179．.
26. Mihalache F， Tantau M， Diaconu B， et al. Survival and quality of life of cholangiocarcinoma patients：a prospective study over a 4 year period [J]. J Gastrointestin Liver Dis， 2010， 19(3)： 285-290.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment Experience of Type Ⅳ Hilar Cholangiocarcinoma

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