Abstract
Background
The objective of this study was to determine the impact of caudate resection on margin
status and outcomes during resection of extrahepatic hilar cholangiocarcinoma.
Methods
A database of 1,092 patients treated for biliary malignancies at institutions of the
Extrahepatic Biliary Malignancy Consortium was queried for individuals undergoing
curative-intent resection for extrahepatic hilar cholangiocarcinoma. Patients who
did versus did not undergo concomitant caudate resection were compared with regard
to demographic, baseline, and tumor characteristics as well as perioperative outcomes.
Results
A total of 241 patients underwent resection for a hilar cholangiocarcinoma, of whom
85 underwent caudate resection. Patients undergoing caudate resection were less likely
to have a final positive margin (P = .01). Kaplan-Meier curve of overall survival for patients undergoing caudate resection
indicated no improvement over patients not undergoing caudate resection (P = .16). On multivariable analysis, caudate resection was not associated with improved
overall survival or recurrence-free survival, although lymph node positivity was associated
with worse overall survival and recurrence-free survival, and adjuvant chemoradiotherapy
was associated with improved overall survival and recurrence-free survival.
Conclusion
Caudate resection is associated with a greater likelihood of margin-negative resection
in patients with extrahepatic hilar cholangiocarcinoma. Precise preoperative imaging
is critical to assess the extent of biliary involvement, so that all degrees of hepatic
resections are possible at the time of the initial operation.
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References
- Cancer statistics, 2016.CA Cancer J. 2016; 66: 7-30
- Resectable hilar cholangiocarcinoma: surgical treatment and long-term outcome.Surg Today. 2004; 34: 885-890
- Hilar cholangiocarcinoma: expert consensus statement.HPB (Oxford). 2015; 17: 691-699
- Perioperative management of hilar cholangiocarcinoma.J Gastrointest Surg. 2015; 19: 1889-1899
- Principles of surgical resection in hilar cholangiocarcinoma.World J Gastrointest Oncol. 2013; 5: 139-146
- Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type III and IV.Eur J Surg Oncol. 2012; 38: 1197-1203
- The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma.HPB (Oxford). 2005; 7: 263-267
- Role of caudate lobectomy in type III A and III B hilar cholangiocarcinoma: a 15-year experience in a tertiary institution.World J Surg. 2012; 36: 1112-1121
- Caudate lobe resections: a single-center experience and evaluation of factors predictive of outcomes.World J Surg Oncol. 2013; 11: 220
- Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience.J Hepatobiliary Pancreat Surg. 2000; 7: 155-162
- Aggressive surgical treatment of hilar cholangiocarcinoma.J Hepatobiliary Pancreat Surg. 1998; 5: 52-61
- Parenchyma-preserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma.J Am Coll Surg. 1999; 189: 575-583
- Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection?.Surgery. 1998; 123: 131-136
- Segments I and IV resection as a new approach for hepatic hilar cholangiocarcinoma.Am J Surg. 1998; 175: 229-231
- Surgical treatment in proximal bile duct cancer. A single-center experience.Ann Surg. 1996; 224: 628-638
- Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system.Ann Surg. 1998; 228: 385-394
Article info
Publication history
Published online: January 03, 2018
Accepted:
October 18,
2017
Footnotes
None of the authors have any conflicts to disclose.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
