Extended resections for hilar cholangiocarcinoma

Objective To evaluate different strategies for extended resections of hilar cholangiocarcinomas on radicality and survival. Summary Background Data Surgical resection of hilar cholangiocarcinoma is t he only potentially curative treatment. Resection of central bile duct car cinemas. however, cannot always comply with the general principles of surgi cal oncology to achieve wide tumor-free margins with no-touch techniques. Methods From 1988 to 1998, 95 patients underwent resection of hilar cholang iocarcinoma. Eighty patients had hilar and hepatic resections and 15 had li ver transplantation and partial pancreatoduodenectomy (LTPP; i.e., eradicat ion of the entire biliary tract using a no-touch technique). Results The 60-day death rate was 8%. The overall 1- and 5-year survival ra tes were 67% and 22%, respectively. Five-year survival rates after RO, R1, and R2 resections were 37%, 9%, and 0%. in a multivariate analysis, surgica l radicality was the strongest determinant of survival (p < 0.001). The rat e of formally curative resection (RO resection) was significantly lower in hilar resections (29%) than in liver resections (left hemihepatectomy 59%, right hemihepatectomy 55%, right trisegmentectomy 65%; p < 0.05). The highe st rate of RO resection was observed after LTPP (93%; p < 0.05). Right tris egmentectomies achieved the highest rate of 5-year survival after RO resect ion (57%). In a multivariate analysis of patient survival after RO resectio n, additional portal Vein resection was the only significant factor. The 5- year survival rate after formally curative liver resection with portal vein resection was 65% versus 28% without. Conclusion Extended resections, especially right trisegmentectomies and LTP P, resulted in the highest rate of R0 resection. Right trisegmentectomy tog ether with portal vein resection best represents the principles of surgical oncology and may be regarded as the surgical pR0cedure of choice. Immunosu ppression limits the applicability of LTPP.