Surgical Treatment and Influence Factors of Prognosis in 189 Cases of Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SUNXue-jun , ZHENGJian-bao , HESai

Department of General Surgery, The First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China;

Corresponding?author：

SUNXue-jun, Email: sunxy@mail.xjtu.edu.cn

Keywords：

Hilar cholangiocarcinoma; Surgery; Prognosis; Influence factor; Cox proportional hazard model

DOI：

10.7507/1007-9424.20140067

Video：

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Objective To summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. Methods Clinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. Results Of 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. Conclusions Radical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.

Citation： SUNXue-jun, ZHENGJian-bao, HESai. Surgical Treatment and Influence Factors of Prognosis in 189 Cases of Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 273-277. doi: 10.7507/1007-9424.20140067 Copy

1.	?Klatskin G. Adenocarcinoma of the hepatic duct atits bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features[J]. Am J Med, 1965, 38:241-256.
2.	Saxena A, Chua TC, Chu FC, et al. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma:a critical analysis of recurrence and survival[J]. Am J Surg, 2011, 202(3):310-320.
3.	唐文皓, 唐健雄, 袁祖榮.肝門部膽管癌的治療現狀[J].國際外科學雜志, 2012, 39(5):296-298.
4.	Zhimin G, Noor H, Jian-Bo Z, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma-a review[J]. Med Sci Monit, 2013, 19:648-656.
5.	Gavrilovici V, Grecu F, Seripcariu V, et al. Classification and staging systems for hilar cholangio-carcinoma (Klatskin tumors):clinical application and practical relevance[J]. Rev Med Chir Soc Med Nat Iasi, 2011, 115(2):412-417.
6.	Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, et al. Risk factors and classifications of hilar cholangiocarcinoma[J]. World J Gastrointest Oncol, 2013, 5(7):132-138.
7.	何效東, 董家鴻, 趙曉雷, 等.肝門部膽管癌的診斷與外科治療[J].中華肝膽外科雜志, 2008, 14(8):582-584.
8.	Marubashi S, Gotoh K, Takahashi H, et al. Prediction of the postoperative prognosis of intrahepatic cholangiocarcinoma (ICC):importance of preoperatively-determined anatomic invasion level and number of tumors[J]. Dig Dis Sci, 2013, 12.[Epub ahead of print].
9.	黃志強.肝門部膽管癌外科治療的現狀與我見[J].中國實用外科雜志, 2007, 27(5):341-346.
10.	張永杰.肝門部膽管癌外科治療的術式選擇及評價[J].中國實用外科雜志, 2007, 27(5):358-361.
11.	王越, 侴偉平, 葛春林.肝門部膽管癌患者生存預測模型的分析[J].中國普外基礎與臨床雜志, 2011, 18(6):590-594.
12.	Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioper-ative and long-term outcome after surgical treatment of hilar cholang-iocarcinoma:results of an Italian multicenter analysis of 440 patients[J]. Arch Surg, 2012, 147(1):26-34.
13.	Lim JH, Choi GH, Choi SH, et al. Liver resection for Bismuth typeⅠand typeⅡhilar cholangiocarcinoma[J]. World J Surg, 2013, 37(4):829-837.
14.	Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4:prognostic factors and longterm outcomes[J]. J Am Coll Surg, 2007, 204(2):250-260.
15.	Izbicki JR, Tsui TY, Bohn BA, et al. Surgical strategies in patients with advanced hilar cholangiocarcinoma (Klatskin tumor)[J]. J Gastrointest Surg, 2013, 17(3):581-585.
16.	Rosen CB, Darwish Murad S, Heimbach JK, et al. Neoadjuvant therapy and liver transplantation for hilar cholangiocarcinoma:is pretreatment pathological confirmation of diagnosis necessary?[J]. J Am Coll Surg, 2012, 215(1):31-38.
17.	Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma[J]. World J Gastroenterol, 2013, 19(48):9209-9215.
18.	Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma[J]. Transpl Int, 2010, 23(7):692-697.
19.	孫學軍, 石景森, 何平.影響膽管癌切除術后的預后因素分析[J].中國普外基礎與臨床雜志, 2006, 13(1):85-88.
20.	Puhalla H, Gruenberger T, Pokorny H, et al. Resection of hilar cholangiocarcinomas:pivotal prognostic factors and impact of tumor sclerosis[J]. World J Surg, 2003, 27(6):680-684.
21.	何平, 石景森, 陳武科, 等.應用Cox模型分析影響膽管癌切除術后的預后因素[J].中華肝膽外科雜志, 2002, 8(4):219-221.
22.	Cannon RM, Brock G, Buell JF. Surgical resection for hilar cholangiocarcinoma:experience improves resectability[J]. HPB (Oxford), 2012, 14(2):142-149.
23.	Serrablo A, Tejedor L. Outcome of surgical resection in Klatskin tumors[J]. World J Gastrointest Oncol, 2013, 5(7):147-158.
24.	Guglielmi A, Ruzzenente A, Campagnaro T, et al. Prognostic significance of lymph node ratio after resection of peri-hilar cholangiocarcinoma[J]. HPB (Oxford), 2011, 13(4):240-245.
25.	Nagino M. Perihilar cholangiocarcinoma:a surgeon's viewpoint on current topics[J]. J Gastroenterol, 2012, 47(11):1165-1176.

1. ?Klatskin G. Adenocarcinoma of the hepatic duct atits bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features[J]. Am J Med, 1965, 38:241-256.
2. Saxena A, Chua TC, Chu FC, et al. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma:a critical analysis of recurrence and survival[J]. Am J Surg, 2011, 202(3):310-320.
3. 唐文皓, 唐健雄, 袁祖榮.肝門部膽管癌的治療現狀[J].國際外科學雜志, 2012, 39(5):296-298.
4. Zhimin G, Noor H, Jian-Bo Z, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma-a review[J]. Med Sci Monit, 2013, 19:648-656.
5. Gavrilovici V, Grecu F, Seripcariu V, et al. Classification and staging systems for hilar cholangio-carcinoma (Klatskin tumors):clinical application and practical relevance[J]. Rev Med Chir Soc Med Nat Iasi, 2011, 115(2):412-417.
6. Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, et al. Risk factors and classifications of hilar cholangiocarcinoma[J]. World J Gastrointest Oncol, 2013, 5(7):132-138.
7. 何效東, 董家鴻, 趙曉雷, 等.肝門部膽管癌的診斷與外科治療[J].中華肝膽外科雜志, 2008, 14(8):582-584.
8. Marubashi S, Gotoh K, Takahashi H, et al. Prediction of the postoperative prognosis of intrahepatic cholangiocarcinoma (ICC):importance of preoperatively-determined anatomic invasion level and number of tumors[J]. Dig Dis Sci, 2013, 12.[Epub ahead of print].
9. 黃志強.肝門部膽管癌外科治療的現狀與我見[J].中國實用外科雜志, 2007, 27(5):341-346.
10. 張永杰.肝門部膽管癌外科治療的術式選擇及評價[J].中國實用外科雜志, 2007, 27(5):358-361.
11. 王越, 侴偉平, 葛春林.肝門部膽管癌患者生存預測模型的分析[J].中國普外基礎與臨床雜志, 2011, 18(6):590-594.
12. Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioper-ative and long-term outcome after surgical treatment of hilar cholang-iocarcinoma:results of an Italian multicenter analysis of 440 patients[J]. Arch Surg, 2012, 147(1):26-34.
13. Lim JH, Choi GH, Choi SH, et al. Liver resection for Bismuth typeⅠand typeⅡhilar cholangiocarcinoma[J]. World J Surg, 2013, 37(4):829-837.
14. Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4:prognostic factors and longterm outcomes[J]. J Am Coll Surg, 2007, 204(2):250-260.
15. Izbicki JR, Tsui TY, Bohn BA, et al. Surgical strategies in patients with advanced hilar cholangiocarcinoma (Klatskin tumor)[J]. J Gastrointest Surg, 2013, 17(3):581-585.
16. Rosen CB, Darwish Murad S, Heimbach JK, et al. Neoadjuvant therapy and liver transplantation for hilar cholangiocarcinoma:is pretreatment pathological confirmation of diagnosis necessary?[J]. J Am Coll Surg, 2012, 215(1):31-38.
17. Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma[J]. World J Gastroenterol, 2013, 19(48):9209-9215.
18. Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma[J]. Transpl Int, 2010, 23(7):692-697.
19. 孫學軍, 石景森, 何平.影響膽管癌切除術后的預后因素分析[J].中國普外基礎與臨床雜志, 2006, 13(1):85-88.
20. Puhalla H, Gruenberger T, Pokorny H, et al. Resection of hilar cholangiocarcinomas:pivotal prognostic factors and impact of tumor sclerosis[J]. World J Surg, 2003, 27(6):680-684.
21. 何平, 石景森, 陳武科, 等.應用Cox模型分析影響膽管癌切除術后的預后因素[J].中華肝膽外科雜志, 2002, 8(4):219-221.
22. Cannon RM, Brock G, Buell JF. Surgical resection for hilar cholangiocarcinoma:experience improves resectability[J]. HPB (Oxford), 2012, 14(2):142-149.
23. Serrablo A, Tejedor L. Outcome of surgical resection in Klatskin tumors[J]. World J Gastrointest Oncol, 2013, 5(7):147-158.
24. Guglielmi A, Ruzzenente A, Campagnaro T, et al. Prognostic significance of lymph node ratio after resection of peri-hilar cholangiocarcinoma[J]. HPB (Oxford), 2011, 13(4):240-245.
25. Nagino M. Perihilar cholangiocarcinoma:a surgeon's viewpoint on current topics[J]. J Gastroenterol, 2012, 47(11):1165-1176.

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Surgical Treatment and Influence Factors of Prognosis in 189 Cases of Hilar Cholangiocarcinoma

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