Portal Vein Resection in Management of Hilar... : Journal of the American College of Surgeons (original) (raw)

Southern Surgical Association article

Portal Vein Resection in Management of Hilar Cholangiocarcinoma

Hemming, Alan W. MD, MSc, FACSa,*; Mekeel, Kristin MDa; Khanna, Ajai MD, FACSa; Baquerizo, Angeles MDa; Kim, Robin D. MD, FACSb

aDepartment of Surgery, Center for Hepatobiliary Disease and Abdominal Transplantation, University of California San Diego, San Diego, CA

bDepartment of Surgery, University of Florida, Gainesville, FL

Correspondence address: Alan W Hemming, MD, MSc, FACS, Center for Hepatobiliary Diseases, University of California San Diego, Suite 2-280, 200 West Arbor Dr, #8401, San Diego, CA 92013-8401

E-mail: [email protected]

Submitted December 10, 2010; accepted December 15, 2010.

Disclosure Information: Nothing to disclose.

Presented at Southern Surgical Association 122nd Annual Meeting, Palm Beach, FL, December 2010.

Abstract

Background

Vascular reconstruction along with major liver resection in the setting of liver dysfunction caused by biliary obstruction can be associated with increased risk. The purpose of this report is to assess the role of portal vein resection and reconstruction in the surgical management of hilar cholangiocarcinoma.

Study Design

Ninety-five patients with hilar cholangiocarcinoma who underwent resection between 1999 and 2010 were reviewed. Liver resections performed along with biliary resection included 84 trisegmentectomies (63 right, 21 left) and 11 lobectomies (8 left, 3 right). Thirteen patients also had simultaneous pancreaticoduodenectomy performed. Forty-two patients underwent portal vein resection and reconstruction. Five patients required reconstruction of the hepatic artery. Preoperative portal vein embolization was used in 38 patients.

Results

Patients undergoing resection had a 5% mortality rate, with an overall morbidity rate of 36%. Patients who underwent portal vein resection had perioperative mortality and morbidity similar to those who did not have portal vein resection. Median survival was 38 months (95% CI, 29–51 months), with a 5-year survival rate of 43%. There was no difference in long-term survival between those patients who had portal vein resection and those that did not. Negative margins were achieved in 84% of cases and were associated with improved survival (p < 0.01). Five-year survival rate in patients undergoing R0 resection was 50%. Patients with positive lymph nodes appeared to have a worse 5-year survival rate than patients with node-negative status (23% versus 49%); however, only negative margin status was associated with improved survival by multivariate analysis.

Conclusions

Surgical resection of hilar cholangiocarcinoma that requires resection of the portal vein can be performed safely and should not be a contraindication to resection.