2008 Annual Meeting Abstracts
Results of aggressive surgical resection for hilar cholangiocarcinoma
Mohamed Akoad, MD, Kashayar Vakili, MD, Kenneth McPartland, MD, James J. Pomposelli, MD, Elizabeth A. Pomfret, MD, David W. Lewis, MD, Roger L. Jenkins, MD.
The Lahey Clinic Medical Center, Burlington, MA, USA.
Objective: Complete surgical excision with negative histologic margins remains the only hope for long-term survival for patient with hilar cholangiocarcinoma. Partial hepatectomy and hilar vascular resection are sometimes necessary to achieve negative margins. This study examines the results of this aggressive surgical approach and its impact on patient survival.
Design: Retrospective analysis of clinical records.
Setting: Tertiary care referral center.
Patients: 122 patients with hilar cholangiocarcinoma who underwent resection with curative intent. 65 patients between 1986-1998 at the former New England Deaconess Hospital (period 1), and 59 patients between 1999-2007 at the Lahey Clinic (period 2)
Interventions: Resection of the extrahepatic biliary tree+hepatic resection+hilar vascular resection.
Main Outcome Measures: Morbididty, mortality, and patient survival.
Results: The overall 1,3, and 5 years survival in patient with R0 resection was 92.9%, 67.5%, and 38.3% compared to 72%, 3.5% and 0% for R1 resection (P<.001). Local and hepatic resection was performed in 75.9% in period 2 compared to 48.6% in period 1. Combined vascular resection was performed in 17 patients (3 in period 1 and 14 in period 2): 13 portal vein resection only, 2 hepatic artery only resection, and 2 both hepatic artery and portal vein resection. Negative margins were achieved in 86.8% in period 2 compared to 50% in period 1(P<0.05). The perioperative mortality was 6% in period 1 and 5% in period 2 (P=NS). The 1,3, and 5 year survival in period 1 was 83.1%, 56.1%, and 13.6% compared to 89.1%, 56%, and 32.5% in period 2 (p=0.007).
Conclusions: The application of agressive surgery with the addition of partial hepatectomy and vascular reconstruction in treating hilar cholangiocarcinoma improves patient survival with acceptable morbidity and mortality.