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Diagnosis and treatment for advanced hilar cholangiocarcinoma:
experience of 24 cases |
| ZHANG Zongming1, ZHU Jianping1, SU Yanming1, GUO Jinxing1, JIANG Nan1, ZHANG Zichao1, XING Hailin2, LIU Kai2, YUAN Haiming3 |
| 1.Department of General Surgery, Digestive Medical Center, the First Affiliated Hospital of Tsinghua University; 2.First Department of General Surgery, Tongji Hospital, Tongji University; 3.Department of General Surgery, Wuhai People's Hospital |
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Abstract The aim of this paper is to evaluate the efficacy of the surgical treatment for advanced hilar cholangiocarcinoma (CCA) in order to improve the resection rate and curative effect. A retrospective analysis was performed on the data of 24 patients who had undergone surgical treatment for advanced hilar CCA. According to the Bismuth classification, there were four cases of type IIIa, six cases of type IIIb, and 14 cases of type IV. Based on the treatment approaches, these patients were divided into three groups: $` Radical resection group: There were five cases (one type IIIa, three type IIIb, and one type IV). The tumor visible to the naked eyes was resected thoroughly and the cut margin was free of tumor by microscopic examination. Then, Roux-en-Y hepatico-jejunal anastomosis was performed to restore the bile flow. $a Palliative resection group: There were 11 cases. The bile flow was restored by Roux-en-Y hepatico-jejunal anastomosis directly in five cases (two type IIIa, three type IIIb) and by internal drainage through a hepatico-jejunal bridge in the other six cases (one type IIIa, five type IV). $b Simple internal biliary drainage group: There were eight cases of type IV, including three cases with the internal drainage through hepatico-jejunal bridge by laparotomy, three cases with endoscopic retrograde biliary drainage (ERBD), two cases with percutaneous transhepatic biliary drainage (PTBD). The rate of radical resection was 20.8% and the overall resection rate was 66.7%. All of the 24 patients were followed-up. The cumulative surviving rates were significantly different among these three groups (Log-rank ?2 = 17.56, P = 0.0002). For advanced hilar CCA, the best choice of treatment is radical resection. If radical resection is impractical, palliative resection combined with partial hepatectomy can significantly prolong the survival time. Internal drainage through a hepatico-jejunal bridge can enhance the surgical resection rate and decrease the occurrence rate of postoperative biliary leakage.
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Issue Date: 05 June 2008
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| 1 |
Hasegawa S Ikai I Fujii H Hatano E Shimahara Y Surgical resection of hilar CCA: analysisof survival and postoperative complicationsWorld J Surg 2007 31(6)12561263.
doi:10.1007/s00268‐007‐9001‐y
|
| 2 |
Hemming A W Kim R D Mekeel K L Fujita S Reed A I Foley D P Howard R J Portal vein resection for hilarCCAAm Surg 2006 72(7)599604
|
| 3 |
Jonas S Benckert C Thelen A Lopez-Hänninen E Rösch T Neuhaus P Radical surgery for hilar CCAEur J Surg Oncol 2007 [Epub ahead ofprint]
|
| 4 |
Neuhaus P Jonas S Settmacher U Thelen A Benckert C Lopez-Hänninen E Hintze R E Surgical management of proximalbile duct cancer: extended right lobe resection increases resectabilityand radicalityLangenbecks Arch Surg 2003 388(3)194200.
doi:10.1007/s00423‐003‐0383‐5
|
| 5 |
Otani K Chijiiwa K Kai M Ohuchida J Nagano M Tsuchiya K Kondo K Outcome of surgical treatmentof hilar CCAJ Gastrointest Surg 2007 [Epub ahead of print]
|
| 6 |
Launois B Terblanche J Lakehal M Catheline J M Bardaxoglou E Landen S Campion J P Sutherland F Meunier B Proximalbile duct cancer: high resectability rate and 5-year survivalAnn Surg 1999 230(2)266275.
doi:10.1097/00000658‐199908000‐00018
|
| 7 |
Miyazaki M Kato A Ito H Kimura F Shimizu H Ohtsuka M Yoshidome H Yoshitomi H Furukawa K Nozawa S Combined vascular resection in operativeresection for hilar CCA: does it work or not?Surgery 2007 141(5)581588.
doi:10.1016/j.surg.2006.09.016
|
| 8 |
Liu Y D Wang Z Q Wang X D Yang Y S Linghu E Q Wang W F Li W Cai F C Stent implantation through rendezvous technique of PTBDand ERCP: the treatment of obstructive jaundiceJ Dig Dis 2007 8(4)198202.
doi:10.1111/j.1751‐2980.2007.00305.x
|
| 9 |
Singhal D van Gulik T M Gouma D J Palliative management of hilar CCASurg Oncol 2005 14(2)5974.
doi:10.1016/j.suronc.2005.05.004
|
| 10 |
Chiou Y Y Tseng H S Chiang J H Hwang J I Chou Y H Chang C Y Percutaneousplacement of metallic stents in the management of malignant biliaryobstructionJ Formos Med Assoc 2005 104(10)738743
|
| 11 |
Thelen A Neuhaus P Liver transplantation for hilarCCAJ Hepatobiliary Pancreat Surg 2007 14(5)469475.
doi:10.1007/s00534‐006‐1196‐z
|
| 12 |
Pandey D Lee K H Tan K C The role of liver transplantation for hilar CCAHepatobiliary Pancreat Dis Int 2007 6(3)248253
|
| 13 |
He X S Zhang S Zhu X F Wang D P Ma Y Wang G D Ju W Q Wu L W Huang J F Orthotopic liver transplantationwith hepatopancreato-duodenectomy for hilar CCAChin Med J(Engl) 2007 120(3)251253
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