| Autor: |
Jegatheeswaran S; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK., Stathakis P; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK., Spiers HVM; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK., Mohammed F; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK., Petras P; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK., Satyadas T; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK., Parker MJ; Critical Care Medicine, Manchester Royal Infirmary, Manchester M13 9WL, UK., Lamarca A; Christie Hospital, Palatine Road, Manchester M20 4BX, UK., Jamdar S; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK.; Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK., Sheen AJ; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK.; Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.; Centre of Biosciences, Manchester Metropolitan University, Manchester M15 6BH, UK., Siriwardena AK; Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK.; Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK. |
| Abstrakt: |
Background: This study reports the outcome of a work-up programme for resection of peri-hilar cholangiocarcinoma (PH-CCA) without the use of staging laparoscopy. Methods: This is a clinical case cohort series of patients undergoing surgical resection of PH-CCA without the use of staging laparoscopy in the work-up algorithm. During the 13 years from 1 January 2009 to 1 January 2022, 32 patients underwent laparotomy for planned surgical resection of PH-CCA. Data were collected on demographic profile, admission biochemistry, radiology, pre-operative intervention, operation and outcome, together with post-operative complications and disease-free and overall survival. Results: All patients underwent pre-operative contrast-enhanced CT. Twenty-four (75%) underwent pre-operative MR. Twenty-three (72%) underwent pre-operative biliary drainage. Twenty-nine patients (91%) had either type III or IV peri-hilar cholangiocarcinoma. One patient (3%) in this series underwent a non-resectional laparotomy. Twenty-nine (91%) had a final histopathological diagnosis of PH-CCA. One further patient had a final diagnosis of an intraductal papillary neoplasm of the biliary tree (IPNB) with high-grade dysplasia but no invasive cancer. Eleven patients (36%) received chemotherapy after surgery. The median (95% CI) time to recurrence was 14 (7-31) months. The median survival was 25 (18-upper limit not reached) months. Conclusion: This cohort of 32 patients undergoing attempted resection for PH-CCA without the use of staging laparoscopy in the work-up algorithm indicates that with careful attention to patient fitness and cross-sectional and interventional radiologic/endoscopic imaging, a very low non-therapeutic laparotomy rate of 3% can be achieved and sustained. |
