Background and Aims: For hilar cholangiocarcinoma (HCCA), the R0 resection rate remains unsatisfactory. At present, there are still many controversies with regard to the preoperative evaluation, preoperative biliary drainage, portal vein embolization, surgical resection scope, surgical methods, vascular resection, lymph node dissection, chemotherapy and other issues. R0 resection is considered to be the most important treatment method for HCCA patients. Here, the authors summarize the experience in treatment of HCCA, and analyze the effectiveness as well as the short- and long-term efficacy of different surgical methods.
Methods: The clinical data of 44 patients with HCCA undergoing surgical treatment from January 2015 to January 2020 were retrospectively analyzed.
Results: Among the 44 patients, 5 cases were classified as Bismuth-Corlette type I, 7 cases were type II,
8 cases were type IIIa, 13 cases were type IIIb and 11 cases of type IV; 29 cases underwent hemihepatectomy/extended hemihepatectomy plus caudate lobectomy (combined hemihepatectomy), and 13 cases underwent hilar hepatectomy/perihilar hepatectomy plus caudate lobectomy (perihilar hepatectomy), including partial portal vein resection plus repair in 2 cases, portal vein resection plus reconstruction in 2 cases and hepatic artery resection plus reconstruction in 2 cases, and anther 2 cases underwent T-tube drainage only due to unresectable metastases. Operation was completed in all patients, with no surgical death. The postoperative pathological findings showed that there was negative microscopic margin (R0) in 37 cases (26 cases in combined hemihepatectomy group and 11 cases in perihilar hepatectomy group), and positive microscopic margin (R1) in 5 cases (2 cases in combined hemihepatectomy group and 3 cases in perihilar hepatectomy group). Results of clinical variable analysis showed that the operative time (240.4 min vs. 358.1 min), intraoperative blood loss (705.5 mL vs. 809.9 mL) and rate of positive margin of the resected specimens (6.9% vs. 23.1%) were all significantly reduced in combined hemihepatectomy group compared with perihilar hepatectomy group (all P<0.05). The results of survival analysis showed that the recurrence-free survival time and 1-year accumulate survival rate in combined hemihepatectomy group were all superior to those in perihilar hepatectomy group (both P<0.05).
Conclusion: Radical R0 resection is the only chance of cure for HCCA patients. Compared with perihilar hepatectomy, the large scope hepatectomy hemihepatectomy plus caudate lobectomy can improve the R0 resection rate, recurrence-free survival and 1-year survival rate. Accurate preoperative evaluation, appropriate perioperative treatment and selection of individualized operation plan can improve the curative effect of HCCA.