Total laparoscopic radical resection in treatment of hilar cholangiocarcinoma (report of 6 cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DU Yusheng ^1,2 ,  ZHAO Wenxing ² , WANG Ji ² , MA Hongqin ²

1. Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;
2. Department of Tumor Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding?author：

ZHAO Wenxing, Email: wxzhao@sina.com

Keywords：

hilar cholangiocarcinoma; laparoscope; minimally invasive surgery

DOI：

10.7507/1007-9424.201706139

Video：

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Objective To explore safety and efficacy of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods From April 2016 and January 2017, 6 patients with hilar cholangiocarcinoma underwent laparoscopic radical resection in the Affiliated Hospital of Xuzhou Medical University were collected. The intra- and post-operative situation and the postoperative complications were analyzed. Results The radical resections of hilar cholangiocarcinoma were completed laparoscopically in all the patients. There was no conversion to the laparotomy. The procedure was finished within a time of (231.3±94.5) min and with an intraoperative blood loss of (123.3±46.8) mL. The first postoperative exhausting time and the postoperative hospital stay was (2.7±0.3) d and (11.9±1.7) d, respectively. All the patients had the R0 resection and the numbers of dissected lymph nodes were 9.4±2.7. The postoperative complications occurred in 2 patients, they were all cured spontaneously in one week, and there was no perioperative death. None of patients had a local recurrence and metastasis during an average 8 months of following-up. Conclusions Preliminary results of limited cases in this study show that with suitable case and skillful laparoscopic technique, laparoscopic radical resection of hilar cholangiocarcinoma is feasible and safe. Further studies are still needed to confirm benefits of this approach.

Citation： DU Yusheng, ZHAO Wenxing, WANG Ji, MA Hongqin. Total laparoscopic radical resection in treatment of hilar cholangiocarcinoma (report of 6 cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(12): 1487-1491. doi: 10.7507/1007-9424.201706139 Copy

1.	張雯雯, 呂少誠, 史憲杰, 等. 單中心 30 年膽道外科疾病譜的變化趨勢及意義. 中華醫學雜志, 2016, 96(24): 1912-1915.
2.	DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg, 2007, 245(5): 755-762.
3.	Matsuo K, Rocha FG, Ito K, et al. The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg, 2012, 215(3): 343-355.
4.	Molina V, Sampson J, Ferrer J, et al. Surgical treatment of perihilar cholangiocarcinoma: early results of en bloc portal vein resection. Langenbecks Arch Surg, 2017, 402(1): 95-104.
5.	殷曉煜, 劉鑫, 陳偉, 等. 肝門部膽管癌手術切除的遠期療效及預后因素分析. 中華消化外科雜志, 2016, 15(4): 329-334.
6.	Matsuyama R, Mori R, Ota Y, et al. Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol, 2016, 23(Suppl 4): 475-484.
7.	Kang MJ, Jang JY, Chang J, et al. Actual long-term survival outcome of 403 consecutive patients with hilar cholangiocarcinoma. World J Surg, 2016, 40(10): 2451-2459.
8.	張輝, 王孟龍. 單中心 56 例肝門部膽管癌的外科治療. 中華肝膽外科雜志, 2017, 23(1): 16-19.
9.	Li HZ, Chen JX, Zheng Y, et al. Laparoscopic-assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. J Surg Oncol, 2016, 113(7): 756-767.
10.	王文斌, 閆長青, 呂海濤, 等. 腹腔鏡與開腹胰十二指腸切除術療效分析. 中華肝膽外科雜志, 2017, 23(2): 110-113.
11.	朱安東, 劉奇, 陳德興. 腹腔鏡輔助下肝門部膽管癌根治術 38 例. 中國微創外科雜志, 2012, 12(9): 783-786.
12.	Cho A, Yamamoto H, Kainuma O, et al. Laparoscopy in the management of hilar cholangiocarcinoma. World J Gastroenterol, 2014, 20(41): 15153-15157.
13.	Ikeyama T, Nagino M, Oda K, et al. Surgical approach to Bismuth type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg, 2007, 246(6): 1052-1057.
14.	Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis, 2015, 30(2): 159-171.
15.	Sakamoto Y, Shimada K, Nara S, et al. Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: an analysis of the surgical procedures, surgical margins, and survivals of 77 patients. J Gastrointest Surg, 2010, 14(2): 335-343.
16.	中國醫師協會外科醫師分會膽道外科醫師委員會. 膽道手術加速康復外科專家共識(2016 版). 中華消化外科雜志, 2017, 16(1): 6-13.
17.	Park MJ, Kim YK, Lim S, et al. Hilar cholangiocarcinoma: value of adding DW imaging to gadoxetic acid-enhanced MR imaging with MR cholangiopancreatography for preoperative evaluation. Radiology, 2014, 270(3): 768-776.
18.	Myatra S, Divatia JV, Jibhkate B, et al. Preoperative assessment and optimization in periampullary and pancreatic cancer. Indian J Cancer, 2011, 48(1): 86-93.
19.	Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
20.	陳軍, 錢葉本. CT 三維重建在肝門部膽管癌診療中的價值. 肝膽外科雜志, 2015, 23(1): 37-40.
21.	陳祖兵, 沈世強. 肝門部膽管癌的圍肝門膽管切除術. 國際外科學雜志, 2016, 43(7): 436-438.
22.	胡建昆, 陳志新, 張波, 等. 胃癌根治術中 No.8 淋巴結清掃的意義和技巧. 中國普外基礎與臨床雜志, 2007, 14(5): 560-563.
23.	張永杰, 俞文隆, 楊玨, 等. 肝門部膽管癌外科治療的選擇與療效. 中華肝膽外科雜志, 2008, 14(9): 596-600.
24.	Scurtu RR, Dindelegan G, Bintintan V, et al. Extension of hepatic resection ameliorates survival in patients with type Ⅲa or Ⅲb Klatskin tumors despite surgical complications. Chirurgia (Bucur), 2017, 112(3): 301-307.
25.	Chen D, Zhu A, Zhang Z. Total laparoscopic Roux-en-Y cholangiojejunostomy for the treatment of biliary disease. JSLS, 2013, 17(2): 178-187.

1. 張雯雯, 呂少誠, 史憲杰, 等. 單中心 30 年膽道外科疾病譜的變化趨勢及意義. 中華醫學雜志, 2016, 96(24): 1912-1915.
2. DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg, 2007, 245(5): 755-762.
3. Matsuo K, Rocha FG, Ito K, et al. The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg, 2012, 215(3): 343-355.
4. Molina V, Sampson J, Ferrer J, et al. Surgical treatment of perihilar cholangiocarcinoma: early results of en bloc portal vein resection. Langenbecks Arch Surg, 2017, 402(1): 95-104.
5. 殷曉煜, 劉鑫, 陳偉, 等. 肝門部膽管癌手術切除的遠期療效及預后因素分析. 中華消化外科雜志, 2016, 15(4): 329-334.
6. Matsuyama R, Mori R, Ota Y, et al. Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol, 2016, 23(Suppl 4): 475-484.
7. Kang MJ, Jang JY, Chang J, et al. Actual long-term survival outcome of 403 consecutive patients with hilar cholangiocarcinoma. World J Surg, 2016, 40(10): 2451-2459.
8. 張輝, 王孟龍. 單中心 56 例肝門部膽管癌的外科治療. 中華肝膽外科雜志, 2017, 23(1): 16-19.
9. Li HZ, Chen JX, Zheng Y, et al. Laparoscopic-assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. J Surg Oncol, 2016, 113(7): 756-767.
10. 王文斌, 閆長青, 呂海濤, 等. 腹腔鏡與開腹胰十二指腸切除術療效分析. 中華肝膽外科雜志, 2017, 23(2): 110-113.
11. 朱安東, 劉奇, 陳德興. 腹腔鏡輔助下肝門部膽管癌根治術 38 例. 中國微創外科雜志, 2012, 12(9): 783-786.
12. Cho A, Yamamoto H, Kainuma O, et al. Laparoscopy in the management of hilar cholangiocarcinoma. World J Gastroenterol, 2014, 20(41): 15153-15157.
13. Ikeyama T, Nagino M, Oda K, et al. Surgical approach to Bismuth type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg, 2007, 246(6): 1052-1057.
14. Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis, 2015, 30(2): 159-171.
15. Sakamoto Y, Shimada K, Nara S, et al. Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: an analysis of the surgical procedures, surgical margins, and survivals of 77 patients. J Gastrointest Surg, 2010, 14(2): 335-343.
16. 中國醫師協會外科醫師分會膽道外科醫師委員會. 膽道手術加速康復外科專家共識(2016 版). 中華消化外科雜志, 2017, 16(1): 6-13.
17. Park MJ, Kim YK, Lim S, et al. Hilar cholangiocarcinoma: value of adding DW imaging to gadoxetic acid-enhanced MR imaging with MR cholangiopancreatography for preoperative evaluation. Radiology, 2014, 270(3): 768-776.
18. Myatra S, Divatia JV, Jibhkate B, et al. Preoperative assessment and optimization in periampullary and pancreatic cancer. Indian J Cancer, 2011, 48(1): 86-93.
19. Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
20. 陳軍, 錢葉本. CT 三維重建在肝門部膽管癌診療中的價值. 肝膽外科雜志, 2015, 23(1): 37-40.
21. 陳祖兵, 沈世強. 肝門部膽管癌的圍肝門膽管切除術. 國際外科學雜志, 2016, 43(7): 436-438.
22. 胡建昆, 陳志新, 張波, 等. 胃癌根治術中 No.8 淋巴結清掃的意義和技巧. 中國普外基礎與臨床雜志, 2007, 14(5): 560-563.
23. 張永杰, 俞文隆, 楊玨, 等. 肝門部膽管癌外科治療的選擇與療效. 中華肝膽外科雜志, 2008, 14(9): 596-600.
24. Scurtu RR, Dindelegan G, Bintintan V, et al. Extension of hepatic resection ameliorates survival in patients with type Ⅲa or Ⅲb Klatskin tumors despite surgical complications. Chirurgia (Bucur), 2017, 112(3): 301-307.
25. Chen D, Zhu A, Zhang Z. Total laparoscopic Roux-en-Y cholangiojejunostomy for the treatment of biliary disease. JSLS, 2013, 17(2): 178-187.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Total laparoscopic radical resection in treatment of hilar cholangiocarcinoma (report of 6 cases)

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