Resectability Evaluation And Clinical Analysis Of Advanced Perihilar Cholangiocarcinoma

Objective: To investigate the surgical treatment for advanced perihilarcholangiocarcinoma with hepatic vascular invasion, analyze the factors inpreoperative evaluation and surgery result, and evaluate the patients’ survival.Methods: We retrospectively analyzed the clinical data of61cases with resectedadvanced perihilar cholangiocarcinoma between January2008and December2012. The61patients were staged with the Clavien staging system preoperatively,including tumor size and form, invasion along the biliary tree, invasion of theportal vein and the hepatic artery, as well as the remnant liver volume. Among the61patients,6patients received bile duct resection with portal vein reconstruction,1patient received bile duct resection with hepatic vein reconstruction,15patientsreceived left hepatectomy with portal vein reconstruction,13patients received lefthepatectomy with hepatic artery reconstruction,4patients received lefthepatectomy with both portal vein and hepatic artery reconstruction,9patientsreceived left tri-sectionectomy with portal vein reconstruction,1patient receivedleft tri-sectionectomy with hepatic artery reconstruction,10patients received righthepatectomy with portal vein reconstruction,1patient received right hepatectomywith hepatic artery reconstruction,1patient received right tri-sectionectomy withboth portal vein and hepatic artery reconstruction. The pathological data of61patients were analyzed and divided into R0group and R1/2group. And patients’survival were analyzed.Results: R0resection were achieved in39patients, the1-,3-, and5-year survivalrates were81%,43%, and37%, respectively. Survival for22patients whounderwent R1/2resection was72%,35%and16%at the1-,3-and5-year timepoints. Although the overall survival (median survival time27months) was worsethan that of278patients with perihilar cholangiocarcinoma who underwent resection without any vascular resection at the same period, however the survivalwas significantly better than the103patients with unresectable perihilarcholangiocarcinoma treated at our department between2008and2012.Conclusions:1) Aggressive surgery with simultaneous vascular reconstructionfor perihilar cholangiocarcinoma could increase the number of resected cases.2)Morbidity and mortality of vascular reconstruction surgery has not been increasedcompared to surgery without vascular reconstruction.3) Patients of advancedPHC with vascular invasion may acquire better survival after aggressive surgerywith resection and reconstruction of the invaded portal vein and/or hepatic artery.