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Surgery for Hilar Cholangiocarcinoma: A Multi-institutional Update on Practice and Outcome by the AFC-HC Study Group

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Surgical resection is the only option for long-term survival in patients with hilar cholangiocarcinoma (HC), but it is associated with high morbidity and mortality. The aim of the present study was to prospectively assess the perioperative management and short-term outcomes of surgical treatment of HC in a recent, multi-institutional study with a short inclusion period.

Methods

Between January and December 2008, a register prospectively collected data on patients operated on for HC (exploratory or curative surgery) in eight tertiary centers. The register focused on perioperative management, resectability, surgical procedures employed, morbidity, and mortality. The study cohort consisted of 56 patients (40 men and 16 women) with a median age of 63 years (range, 33–83 years).

Results

Among the 56 patients, 47 (84%) were jaundiced and 42 (75%) tumors were classified as Bismuth–Corlette type III–IV. Nine patients (16%) underwent staging laparoscopy and four (7%) received neoadjuvant chemotherapy. Preoperative biliary drainage (endoscopy, 42%) was performed in 38 (81%) jaundiced patients and portal vein embolization (right side, 83%) was performed prior to surgery in 18 patients (32%). Among these 56 patients, curative resection was achieved in 39 (70%). All underwent major liver resection (>3 segments), bile duct resection, and lymphadenectomy. Thirteen patients (36%) underwent portal vein resection, one of whom also required pancreaticoduodenectomy. Eighty-two percent of resected patients (n = 32) had no proof of malignancy prior to hepatectomy. Clear surgical margins were obtained in 77% (n = 30). The postoperative mortality was 8% and complications occurred in 72% of the resected patients. Seven (25%) patients required reoperation, and 15 (54%) patients required percutaneous drainage. In a univariate analysis, the risk factors for morbidity were intraoperative blood transfusion (p = 0.009) and vascular clamping (p = 0.006). The median length of hospitalization was 20 ± 13 days.

Conclusion

Curative resection for HC is associated with a high rate of R0 resection. However, surgery is associated with high levels of morbidity and mortality, despite intensive perioperative management.

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Abbreviations

HC:

Hilar cholangiocarcinoma

PVE:

Portal vein embolization

SD:

Standard deviation

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Acknowledgments

The authors wish to thank the following surgeons, who included patients in the study: J Hardwigsen (Hôpital de la Conception, Marseille), P Pessaux (Hôpital Hautepierre, Strasbourg), J Belghiti (Hôpital Beaujon, Clichy), C Ducerf (Hôpital de la Croix Rousse, Lyon), E Boleslawski (Hôpital Huriez, Lille), D Cherqui (Hôpital Henri Mondor, Créteil), A Laurent (Hôpital Henri Mondor, Créteil), G Mantion (Centre Hospitalier Universitaire, Besançon), J Lubrano (Centre Hospitalier Universitaire, Besançon), B Suc (Centre Hospitalier Universitaire, Toulouse), G Fourtanier (Centre Hospitalier Universitaire, Toulouse), G Nuzzo (Université Catholique de Rome), D Bertrand (Hôpital de Jolimont-Lobbes, Belgique), D Dili (Hôpital de Jolimont-Lobbes, Belgique), N Dehni (Centre Hospitalier Universitaire, Brest), O Soubrane (Hôpital Cochin, Paris), O Scatton (Hôpital Cochin, Paris), C Letoublon (Centre Hospitalier Universitaire, Grenoble), D Badic (Centre Hospitalier Universitaire, Grenoble), and M Scotte (Hôpital Charles Nicolle, Rouen).

Conflicts of interest

None of the authors have any financial or personal relationships with other people or organizations that could inappropriately influence (bias) this work.

Responsibility

This multicenter study is an original work not submitted to any other journal. The corresponding author had full access to all study data and has final responsibility for the decision to submit this manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Nord, University of Picardy Medical Center, Place Victor Pauchet, F-80054, Amiens Cedex 01, France

    Jean Marc Regimbeau & David Fuks

  2. Department of Hepatobiliary Surgery, Hôpital Conception, Assistance-Publique Hôpitaux de Marseille, Marseille, France

    Yves-Patrice Le Treut

  3. Department of Hepatobiliary Surgery, Hôpital Hautepierre, Strasbourg, France

    Philippe Bachellier

  4. Department of Hepatobiliary Surgery, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Université Paris 7, Clichy, France

    Jacques Belghiti & Olivier Farges

  5. Department of Hepatobiliary Surgery, Hôpital Pontchaillou, Rennes, France

    Karim Boudjema

  6. Department of Hepatobiliary Surgery, Hôpital Croix Rousse, Lyon, France

    Jacques Baulieux

  7. Department of Hepatobiliary Surgery, Hôpital Claude Huriez, Lille, France

    François-René Pruvot

  8. Department of Hepatobiliary Surgery, Hôpital Mondor, Assistance-Publique Hôpitaux de Paris, Créteil, France

    Daniel Cherqui

Authors
  1. Jean Marc Regimbeau
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  2. David Fuks
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  3. Yves-Patrice Le Treut
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  7. Jacques Baulieux
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  8. François-René Pruvot
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  10. Olivier Farges
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Corresponding author

Correspondence to Jean Marc Regimbeau.

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Authors’ contributions

All authors are justifiably credited with authorship:

For Study conception and design: JM. Regimbeau, O. Farges, and FR. Pruvot;

For Acquisition of data: all authors;

For Analysis and interpretation of data: D. Fuks, JM. Regimbeau, O. Farges;

For Drafting of manuscript: JM. Regimbeau, D. Fuks;

For Critical revision of manuscript: JM. Regimbeau, O. Farges, D. Fuks;

And for Supervision: JM. Regimbeau, O. Farges.

All authors agree with the submission and have given their final approval.

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Regimbeau, J.M., Fuks, D., Le Treut, YP. et al. Surgery for Hilar Cholangiocarcinoma: A Multi-institutional Update on Practice and Outcome by the AFC-HC Study Group. J Gastrointest Surg 15, 480–488 (2011). https://doi.org/10.1007/s11605-011-1414-0

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  • DOI: https://doi.org/10.1007/s11605-011-1414-0

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