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Objectives: The aim of this study was to clarify short- and long-term outcome of extended hepatectomy with portal vein resection (PVR) or hepatic artery resection (HAR) for perihilar cholangiocarcinoma.
Methods: Patients with perihilar cholangiocarcinoma who underwent resection between January 2000 and December 2011 for perihilar cholangiocarcinoma were analyzed retrospectively. Operative variables, mortality, morbidity, and survival were compared among standard resection with no PVR and no HAR (S group), with PVR without HAR (PV group) and with HAR (HA group).
Results: A total 230 patients underwent surgical resection for perihilar cholangiocarcinoma, 172 (75%) in S group, 37 (16%) in PV group, and 21 (9.1%) in HA group were enrolled. Operative time and blood loss were 633minutes and 1415ml in S group, 665 and 2028 in PV group, 775 and 2076ml in HA group, respectively. Those with PV and HA group were significantly more than in those with S group (both P = 0.04). Mortality and more than grade IIIa complications occurred in 4 (2.3%) and 17 (9.9%) patients with S group, in 0 and 5 (14%) with PV group and 0 and 3 (14%) with HA group. The rates of more than Grade IIIa complications were comparable among 3 groups. Overall 5-year survival rate and median survival time were 49% and 47.5 months in S group, 22 and 25.0 in PV group, 21 and 21.4 in HA group. There was significant difference in survival in patients between S and PV, S and HA group, respectively. Especially, patients in HA group with R1 (surgical margin positive) or with severe perineural infiltration were associated with unsatisfactory prognosis, which were not survived for more than 3 years.
Conclusions: PVR and HAR for advanced perihilar cholangiocarcinoma were feasible. It can provide a favorable prognosis in selected patients of advanced perihilar cholangiocarcinoma