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Is radical resection of hilar cholangiocarcinoma plus partial resection of pancreatic head justified for advanced hilar cholangiocarcinoma?
Author(s) -
Liu Fei,
Hu HaiJie,
Ma WenJie,
Wang JunKe,
Ran CongDun,
Regmi Parbatraj,
Li FuYu
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15955
Subject(s) - medicine , surgery , pancreatic fistula , pancreatic head , biliary fistula , bile duct , pathological , hepatectomy , resection , survival rate , incidence (geometry) , gastroenterology , fistula , pancreas , physics , optics
Background To outline our experience with the radical resection of hilar cholangiocarcinoma (HCCA) combined with the partial resection of the pancreatic head (RRHCCAPRPH) as a treatment for HCCA with distal bile duct involvement and to appraise the feasibility of this challenging procedure. Methods Between 2007 and 2017, 205 patients with HCCA who underwent curative surgery at our hospital were included. Among the patients, extrahepatic bile duct resection combined with hepatectomy (EBDRH), RRHCCAPRPH and hepatopancreaticoduodenectomy (HPD) was performed in 168, 21 and 16 patients, respectively. Clinical pathological factors, post‐operative complications and survival were compared between the three groups. Results There was a significant difference in operative blood loss, operative time, post‐operative hospital stay and tumour size between EBDRH group, RRHCCAPRPH group and HPD group ( P < 0.05). In terms of post‐operative complications, there was no statistical difference between the three groups ( P = 0.177). Further analysis showed that the incidence of pancreatic fistula (43.8%) and delayed gastric emptying (25%) after HPD were significantly higher than the other two groups. The median survival time and overall survival rate for 172 patients with R0 resection were 33 months and 85.5% at 1 year, 47.7% at 3 years, 28.4% at 5 years. Furthermore, the 1‐, 3‐ and 5‐year survival rates of patients with EBDRH, RRHCCAPRPH and HPD after R0 resection were 86.2%, 48.7%, 29.2%; 85.0%, 44.0%, 24.7% and 78.6%, 42.9%, 22.9%, respectively ( P = 0.948). Conclusion The RRHCCAPRPH in some selected patients can actually replace HPD as a surgical treatment for HCCA with distal bile duct involvement.