ObjectiveTo explore the clinical significance of hepatectomy combined with vascular reconstruction in hilar cholangiocarcinoma with vascular invasion. MethodsThe 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). ResultsThe 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). ConclusionsHepatectomy 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.
Objective To improve the curative resection rate of hilar cholangiocarcinoma (H-CC).Methods Lileratures about surgical treatment of H-CC were collected and reviewed. Results The crucial points are as follow: ①Early diagnosis; ②Recognition of the invasion to liver; ③Rational resection of the tumor with associated vessels; ④Reduction of postoperative complications. Conclusion Improved longterm resection effects on H-CC is possible.
ObjectiveTo explore the technique of hepatic artery reconstruction in complicated hilar cholangiocarcinoma surgery. MethodThe clinicopathologic data of 3 patients with complicated hilar cholangiocarcinoma with arterial invasion underwent hepatic artery reconstruction in the Department of Hepatopancreatobiliary Center of Beijing Tsinghua Changgung Hospital from March to July 2022 were retrospectively analyzed. ResultsAll 3 patients (case 1–3) were the males, aged 53, 68, and 56 years, respectively, and with hypertension or diabetes; the longitudinal diameters of the tumor were 3.5 cm, 3.0 cm, and 3.2 cm, respectively. All patients had the right hepatic artery invasion. Case 2 and 3 had the arterial stratification. The arterial defects after radical resection were 4.5 cm, 3 cm, and 3 cm, respectively. The right or right posterior hepatic artery was reconstructed by the autotransplantation of right gastroomental artery, the left hepatic artery, and the anterior superior pancreaticoduodenal artery, respectively. After operation, the reconstructed hepatic arteries were unobstructed and free of stenosis, and there were no complications such as bleeding, infection, and thrombosis by Doppler ultrasound and CT angiography. The results of postoperative pathological diagnosis were the hilar cholangiocarcinoma with arterial invasion, and all the incisal edges were negative. ConclusionFrom the preliminary results of 3 cases, it is safe, feasible, and effective to select proper autologous artery (matched in length and caliber) for reconstruction the defective invaded hepatic artery which resected together with hilar cholangiocarcinoma, but the technical difficulty is still relatively high.
ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.