Outcomes after vascular resection during curative-intent resection for hilar cholangiocarcinoma: a multi-institution study from the US extrahepatic biliary malignancy consortium.

Schimizzi GV, Jin LX, Davidson JT, Krasnick BA, Ethun CG, Pawlik TM, Poultsides G, Tran T, Idrees K, Isom CA, Weber SM, Salem A, Hawkins WG, Strasberg SM, Doyle MB, Chapman WC, Martin RCG, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Maithel SK, Fields RC
HPB (Oxford). 2018 20 (4): 332-339

PMID: 29169904 · PMCID: PMC5970648 · DOI:10.1016/j.hpb.2017.10.003

BACKGROUND - Surgical resection is the cornerstone of curative-intent therapy for patients with hilar cholangiocarcinoma (HC). The role of vascular resection (VR) in the treatment of HC in western centres is not well defined.

METHODS - Utilizing data from the U.S. Extrahepatic Biliary Malignancy Consortium, patients were grouped into those who underwent resection for HC based on VR status: no VR, portal vein resection (PVR), or hepatic artery resection (HAR). Perioperative and long-term survival outcomes were analyzed.

RESULTS - Between 1998 and 2015, 201 patients underwent resection for HC, of which 31 (15%) underwent VR: 19 patients (9%) underwent PVR alone and 12 patients (6%) underwent HAR either with (n = 2) or without PVR (n = 10). Patients selected for VR tended to be younger with higher stage disease. Rates of postoperative complications and 30-day mortality were similar when stratified by vascular resection status. On multivariate analysis, receipt of PVR or HAR did not significantly affect OS or RFS.

CONCLUSION - In a modern, multi-institutional cohort of patients undergoing curative-intent resection for HC, VR appears to be a safe procedure in a highly selected subset, although long-term survival outcomes appear equivalent. VR should be considered only in select patients based on tumor and patient characteristics.

Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

MeSH Terms (22)

Aged Bile Duct Neoplasms Cholecystectomy Databases, Factual Female Hepatectomy Hepatic Artery Humans Klatskin Tumor Male Middle Aged Neoplasm Grading Neoplasm Staging Pancreaticoduodenectomy Portal Vein Postoperative Complications Retrospective Studies Risk Factors Time Factors Treatment Outcome United States Vascular Surgical Procedures

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