The Role Of Combined Vascular Resection In The Treatment Of Hilar Cholangiocarcinoma

Part I Combined with vascular resection for the treatment of hilar cholangiocarcinoma--a systematic review and meta-analysisObjective:To investigate the safety and effectiveness of vascular resection in radical surgery for hilar cholangiocarcinoma.Methods:We searched PubMed and the Cochrane Library database, screening literature, compared the dates between vascular resection no vascular resection group. Perioperative indicators includes:postoperative complications, perioperative mortality, RO resection rate,5 year survival rate. Meta analysis was performed using RevMan 5.3.5 software for data analysis.Results:A total of 14 documents included, the overall postoperative complication rate was not statistically significant (OR=1.54; 95% CI 0.77-3.07; P=0.22); there is no significant difference between the vascular resection and vascular resection-free groups in postoperative mortality (OR=1.24; 95% CI 0.52-2.93; P = 0.63), but when combined with arterial resection and reconstruction, postoperative mortality rate was significantly increased than those without resection group (OR = 3.84; 95% CI 1.27-11.63; P = 0.02), Data from patients who received combined VR correlated with higher R0 resection rates (OR = 3.84; 95% CI 1.27-11.63; P = 0.03) and lower 5-year survival rate (OR = 1.9; 95% CI 1.23-2.93; P = 0.004).Conclusion:Combined with vascular resection in the treatment of hilar cholangiocarcinoma is relatively safe and feasible, which helps improve the R0 resection rate and prognosis. With consideration of the limitations in this review, more rigorously designed randomized controlled clinical studies that analyze among vascular resection patients are needed in the future.Part Ⅱ Experimental study on animal liver function of liver hepatectomy combined with hepatic arteryObjective:To study the animal liver function influence of liver hepatectomy combined with hepatic artery.Methods:40 S-D male rats were randomly divided into three groups. Group A: control group, simple underwent open abdomainal and free portal vein, hepatic artery and bile duct; Group B:arterial resection and reconstruction with left hepatectomy and free hilar structures; Group C:hepatectomy without arterial reconstruction, with left hepatectomy hepatic artery ligation and free hilar structures. After model established successfully, postoperative recovery and postoperative mortality were observed, after 24 hours,72 hours and 7 days collect blood serum to detect liver function TB, AST, ALT and ALP in rats. Immunohistochemical detection of PCNA in liver tissue proliferation.Results:Rats underdo left hepatectomy and artery resection revovery slow, some rats death with liver failure changes. Compared to the control group, the liver function in C group were significantly elevated, and then gradually returned to normal but still above normal levels after 7d (P＜0.05). PCNA expression decreased afte7d compared with the control group and group B, and the morpholgropogical liver tissue changes, liver tissue proliferation was inhibited.Conclusions:Liver resection with artery resection affected liver function and its recovery. Hepatectomy does not affect liver regeneration, liver resection combined hepatic artery inhibited liver regeneration.Part III The role of vascular resection in the radical resection of hilar cholangiocarcinoma—a single center experienceObjective:To study the preoperation management and treatment strategies for hilar cholangiocarcinoma and the role of vascular resection in the radical resection of hilar cholangiocarcinoma.Methods:We retrospectively analyzed 142 cases of HC data during 2009.7-2014.1 in our single treatment.After admission ultrasound, MDCT, MRCP to diagnosis, preoperative management includes PBD and dynamic monitoring of liver function, ICG testing.3D assessments were used preoperative to assess tumor invasion and vascular variation cases, surgical planning were designed. The evaluation of postoperative liver volume retention, hepatic functional reserve were compared.Results:142 cases underwent surgery after adequate preoperative preparation and evaluation, of which 96 went R0 resection,16 patients with vascular resection. Of 16 patients,11 cases with left hemihepatectomy and caudate lobe resection in,2 cases underwent left trisegmentectomy,3 cases with right right hemihepatectomy. Portal vein resection performed in 11 cases, in which the portal vein wedge excision in 4 cases, the portal vein anastomosis in 6 cases, right anterior portal vein resection and reconstruction in 1 case. Because of tumor invasion in the right hepatic artery,4 patients underwent right hepatic artery resection and saphenous vein reconstruction, and 1 patient underwent right hepatic artery anastomosis.3D assess Bismuth classification accuracy was 87.5%. Analyzing the overall variation of hepatic artery was 23%.3D evaluate portal vein accuracy was 93.7%, the accurate assessment of arterial invasion was 87.5%. Postoperative complications:one case of bile leakage, no abdominal bleeding and abdominal infection, no vascular thrombosis-related complications,the overall complication rate was 6.25%; no perioperative deaths. The follow-up results are as follows:1 patient died 3 months after surgery,1 died for liver metasis afer 9 months,2 cases lost connection, and the rest we will keep to follow up.Conclusions:Vascular resection for hilar cholangiocarcinoma helps improve tmour resectability rate, improve prognosis in large medical centers. With 3D assessment, preoperative management reasonable surgical strategy can reduce postoperative complications and ensure safety for hilar cholangiocarcinoma resection.