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

Autor: David Fuks, Jacques Belghiti, Philippe Bachellier, Olivier Farges, Karim Boudjema, Daniel Cherqui, Jean Marc Regimbeau, François-René Pruvot, Yves-Patrice Le Treut, Jacques Baulieux
Přispěvatelé: Service de chirurgie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Digestive Surgery and Transplantation, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de chirurgie digestive, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Rok vydání: 2011
Předmět:
Male
Preoperative management
030230 surgery
MESH: Length of Stay
Cholangiocarcinoma
High morbidity
Postoperative Complications
MESH: Aged
80 and over

0302 clinical medicine
MESH: Liver Neoplasms
MESH: Postoperative Complications
Hospital Mortality
Prospective Studies
10. No inequality
Surgical treatment
Aged
80 and over

MESH: Aged
Perioperative management
Liver Neoplasms
Gastroenterology
MESH: Neoplasm Staging
MESH: Hepatectomy
Embolization
Therapeutic

3. Good health
Drainage
Female
030211 gastroenterology & hepatology
Adult
Reoperation
Surgical resection
medicine.medical_specialty
MESH: Reoperation
Perioperative Care
MESH: Drainage
03 medical and health sciences
MESH: Cross-Sectional Studies
medicine
Hepatectomy
Humans
In patient
MESH: Hospital Mortality
MESH: Perioperative Care
Mortality
Aged
Neoplasm Staging
MESH: Humans
MESH: Lymph Node Excision
business.industry
General surgery
MESH: Adult
[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
Length of Stay
Hilar cholangiocarcinoma
MESH: Cholangiocarcinoma
MESH: Male
MESH: Prospective Studies
Surgery
MESH: Embolization
Therapeutic

Cross-Sectional Studies
Lymph Node Excision
Bile Ducts
Morbidity
MESH: Bile Ducts
business
MESH: Female
Zdroj: Journal of Gastrointestinal Surgery
Journal of Gastrointestinal Surgery, Springer Verlag, 2011, 15 (3), pp.480-8. ⟨10.1007/s11605-011-1414-0⟩
Journal of Gastrointestinal Surgery, 2011, 15 (3), pp.480-8. ⟨10.1007/s11605-011-1414-0⟩
ISSN: 1873-4626
1091-255X
DOI: 10.1007/s11605-011-1414-0
Popis: International audience; 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.
Databáze: OpenAIRE