90th Annual Meeting Abstracts
Portal Vein and Hepatic Artery Resection for Hilar Cholangiocarcinoma
*Yee Lee Cheah, MD, Mohamed Akoad, MD, *Khashayar Vakili, MD, James J Pomposelli, MD, PhD, William D Lewis, MD, Elizabeth A Pomfret, MD, PhD, Roger L Jenkins, MD
Lahey Clinic, Burlington, MA
To evaluate the addition of portal vein and/or hepatic artery resection to achieve complete surgical resection in hilar cholangiocarcinoma.
Tertiary academic center
All patients with hilar cholangiocarcinoma treated by a single team of surgeons between 1986 and 2008 were identified from our database. 122 patients underwent resection of extrahepatic bile ducts and hilar lymphadenectomy. Hepatic resection was required in 72 (59%) patients to achieve negative margins. When the tumor was found to involve the portal vein and/or the hepatic artery to the portion of liver being retained, segmental vascular resection and reconstruction was performed.
Main outcome measures:
Operative (60-day) mortality, morbidity and 5-year survival were compared between patients with and without vascular resection.
Eighteen patients underwent vascular resection; portal vein resection in 13 patients, hepatic artery resection in 2 patients, combined portal vein and hepatic artery resection in 2 patients and 1 patient had combined portal vein and inferior vena cava resection. Operative mortality was similar in patients with or without vascular resection (12.9% vs 9.3%). Patients with vascular resection had a higher complication rate of 50% compared to 43%. Negative margins were achieved in 77.7% of patients with vascular resection. Histological invasion into resected vessels was found in 71.4%. The 1 and 5-year survival in patients with vascular resection was 57% and 24% compared to 75% and 20% in those without vascular resection (p>0.05).
Hilar vascular resection can be performed with acceptable mortality in order to achieve negative margins in hilar cholangiocarcinoma.