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Hilar cholangiocarcinoma involving the portal vein bifurcation: long‐term results after resection
Author(s) -
Muñoz Luis,
Roayaie Sasan,
Maman Daniel,
Fishbein Thomas,
Sheiner Patricia,
Emre Sukru,
Miller Charles,
Schwartz Myron E.
Publication year - 2002
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340200025
Subject(s) - medicine , anastomosis , surgery , portal vein , bile duct , hepatectomy , concomitant , resection , radiology
Background/Purpose Resection offers the only potential cure of hilar cholangiocarcinoma. Portal bifurcation involvement is often thought to contraindicate resection. We reviewed our experience with aggressive surgical management in 28 patients with hilar cholangiocarcinoma. Methods All patients underwent hepatectomy and bile duct resection with hepaticojejunostomy. In 10 cases (group 1) the portal bifurcation was involved, necessitating portal resection and reconstruction; 18 (group 2) had no portal involvement. Frozen section of duct margins was routine. Survival was estimated using the Kaplan‐Meier method and compared with the log‐rank test. Results Portal reconstruction in group 1 was by graft interposition (1), venoplasty using the posterior wall of the right portal vein (2), or end‐end anastomosis (7). Hepatectomies included right trisegmentectomy (8), right lobectomy (4), and left lobectomy (16); 20 (71%) had concomitant caudate resection. Median survival was 18 months in group 1 and 32 months in group 2 ( P , not significant [NS]). One‐, 3‐, and 5‐year survivals were 60%, 22%, and 22%, respectively, in group 1 and 70%, 47%, and 38%, respectively, in group 2 ( P = 0.319). Conclusions Portal involvement by hilar cholangiocarcinoma does not contraindicate resection.