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KMID : 0870420070110040047
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2007 Volume.11 No. 4 p.47 ~ p.57
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Analysis of Survival After Portal Vein Resection (PVR) In Combination With Hepatectomy For Hilar Cholangiocarcinoma: An Audit of 51 Cases
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Song Gi-Won
Lee Sung-Gyu
Hwang Shin
Lee Young-Joo
Park Kwang-Min
Kim Ki-Hun
Ahn Chul-Soo
Moon Deok-Bog
Ha Tae-Yong
Ryu Je-Ho
Park Jeong-Ik
Lee Hyo-Jun
Kim Chan-Wook
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Abstract
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Purpose: Although a portal vein resection (PVR) can increase the chance for a successful curative resection, there is debate concerning the balance between the risk of the procedure and the effect on survival in patients with hilar cholangiocarcinoma. Therefore, we performed a retrospective study to determine the safety and survival after PVR for hilar cholangiocarcinoma.
Methods: We analyzed the cumulative survival rate and the associated clinical factors in 301 patients undergoing surgical intervention between June 1989 and June 2005. We divided 259 patients undergoing resection into two groups (51 PVR+ and 208 PVR-) and compared the survival and clinicopathological data.
Results: The 1-, 3- and 5-year survival rate of 186 patients undergoing curative resection was 83.3, 42.0 and 29.3%, respectively. The Bismuth-Corlette type IV, the infiltrative type, presence of perineural invasion, lymphovascular tumor emboli and lymph node metastases were more frequent in the PVR+ group. The survival rate was significantly lower in the PVR+ group but seven patients have survived for more than 5 years. Five (9.8%) operative mortalities occurred. However, the mortality directly related to the PVR was present in only one case. The morbidity and postoperative liver function were not different in comparisons between the two groups. In the PVR+ group, tumor invasion into the portal vein was observed in 28 of 51 patients. The tumor invasion on pathological examination did not affect survival in the PVR+ group.
Conclusion: The results of this study showed that PVR in combination with hepatectomy, for hilar cholangiocarcinoma, could be performed with acceptable safety. Although the PVR has a negative impact on survival, a hepatectomy combined with a PVR can offer long-term survival to a few patients with advanced hilar cholangiocarcinoma.
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KEYWORD
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hilar cholangiocarcinoma, Klatskin’s tumor, portal vein resection, survival rate
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