Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients

Gennaro Nuzzo, Felice Giuliante, Francesco Ardito, Ivo Giovannini, Luca Aldrighetti, Giulio Belli, Fabrizio Bresadola, Fulvio Calise, Raffaele Dalla Valle, Davide F D'Amico, Leandro Gennari, Stefano M Giulini, Alfredo Guglielmi, Elio Jovine, Riccardo Pellicci, Heinrich Pernthaler, Antonio D Pinna, Stefano Puleo, Guido Torzilli, Lorenzo CapussottiUmberto Cillo, Giorgio Ercolani, Massimo Ferrucci, Laura Mastrangelo, Nazario Portolani, Carlo Pulitano', Dario Ribero, Andrea Ruzzenente, Vincenzo Scuderi, Bruno Federico

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

150 Citazioni (Scopus)

Abstract

OBJECTIVE: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. DESIGN: Retrospective multicenter study including 17 Italian hepatobiliary surgery units. PATIENTS: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. MAIN OUTCOME MEASURES: Postoperative mortality, morbidity, overall survival, and disease-free survival. RESULTS: Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (right or right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P = .03 and P = .006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P = .05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. CONCLUSIONS: Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.
Lingua originaleEnglish
pagine (da-a)26-34
Numero di pagine9
RivistaArchives of Surgery
Volume147
DOI
Stato di pubblicazionePubblicato - 2012

Keywords

  • Hilar cholangiocarcinoma
  • Improved results
  • Klatskin tumor
  • Liver resection
  • Main biliary confluence excision
  • Results
  • Surgery

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