Analysis Of The Curative Effect Of Different Surgical Methods For Bismut-Corlette Ⅱ Hilar Cholangiocarcinoma

Objective:To analyze the clinical efficacy and prognosis of extended hepatectomy and perihilar hepatectomy for Bismut-Corlette type Ⅱ hilar cholangiocarcinoma(HCCA),and explore its reasonable treatment strategy.Methods:This is a retrospective follow-up study.The clinical data of 35 patients with Bismuth-Corlette type II HCCA treated surgically at the First Affiliated Hospital of Xinjiang Medical University from January2014 to June 2021 were collected.Among them,18 cases were male and 17 cases were female,aged(62.8±10.7)years.According to different surgical methods,they were divided into extended hepatectomy group(15 cases)and perihilar hepatectomy group(20 cases).Observation indexes:(1)Preoperative general data.(2)Intraoperative and postoperative conditions.(3)Follow-up and survival.(4)Analysis of factors affecting the prognosis of patients.Results:(1)Preoperative general data:The extended hepatectomy group and the perihilar hepatectomy group were statistically compared in terms of gender,age,body mass index,preoperative total bilirubin,preoperative serum albumin,Child-Pugh classification,preoperative yellowing reduction,major comorbidities,tumor length,TNM stage,degree of tumor differentiation,nerve invasion,vascular invasion,lymph node invasion,and the differences were not statistically significant(P>0.05).(2)Intraoperative and postoperative conditions:Statistical comparison of operative time,intraoperative bleeding,postoperative hospital days,and postoperative complications between the extended hepatectomy group and the perihilar hepatectomy group showed statistically significant differences(P < 0.05).There was no statistically significant difference between the two groups in terms of intraoperative blood transfusion demand and vascular resection and reconstruction(P>0.05).(3)Follow-up and survival: All 35 patients were followed up for 25(11,32)months.The cumulative survival rates at 1,2,and 3 years were 86.7%,71.5%,and59.6% in the extended hepatectomy group,respectively,with a follow-up time of 23(15,42)months;the cumulative survival rates at 1,2,and 3 years were 65.0%,43.3%,and 27.1% in the perihilar hepatectomy group,respectively,with a follow-up time of 17(8,28)months,with no statistically significant differences(P > 0.05).(4)Analysis of factors affecting the prognosis of patients: The results of univariate analysis showed that TNM stage and vascular invasion were relevant factors affecting the prognosis of patients with type II HCCA(P < 0.05).The results of multifactorial analysis did not show any independent risk factors affecting the prognosis of patients with type II HCCA(P > 0.05).Conclusion:Extended hepatectomy and Perihilar hepatectomy are both feasible surgical options for achieving radical resection in patients with Bismuth-Corlette type II HCCA,with similar safety and effectiveness.However,patients with extended hepatectomy have a trend towards long-term survival.