Short- and Long-Term Outcomes of Simultaneous Hepatic Artery Resection and Reconstruction for Perihilar Cholangiocarcinoma

Yoshitaro Shindo; Shogo Kobayashi; Hiroshi Wada; Yukio Tokumitsu; Satoshi Matsukuma; Hiroto Matsui; Masao Nakajima; Shin Yoshida; Michihisa Iida; Nobuaki Suzuki; Shigeru Takeda; Yoshinobu Hoshii; Hidetoshi Eguchi; Hiroaki Nagano

doi:10.1159/000511164

Short- and Long-Term Outcomes of Simultaneous Hepatic Artery Resection and Reconstruction for Perihilar Cholangiocarcinoma

Gastrointest Tumors. 2021 Jan;8(1):25-32. doi: 10.1159/000511164. Epub 2020 Nov 10.

Affiliations

¹ Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
² Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
³ Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube, Japan.

Abstract

Introduction: Because surgical resection with simultaneous hepatic artery (HA) resection and reconstruction for perihilar cholangiocarcinoma (PHC) is technically demanding, the surgical indication for this challenging procedure is controversial. Thus, this study aimed to evaluate the efficacy of simultaneous HA resection and reconstruction for PHC.

Methods: Between January 2002 and January 2018, 13 patients with PHC underwent surgical intervention with simultaneous resection and reconstruction of the HA at Yamaguchi University Hospital (Ube, Japan) and Osaka University Hospital (Suita, Japan).

Results: There were 2 cases (15.4%) of 90-day postoperative mortality. Nine patients (69.2%) developed major postoperative complications (Clavien-Dindo classification ≥IIIa). Curative resections (R0) were achieved in 8 cases (61.5%). The median survival time (MST) and 1- and 3-year survival rates after resection (including in-hospital deaths) were 20.9 months and 61.5 and 10.3%, respectively. The MST and 1- and 2-year survival rates of 8 patients who underwent R0 resection were significantly better than those of the other 5 patients (24.2 vs. 10.2 months, 75.0 vs. 40.0%, and 50.0 vs. 0.0%, respectively, p = 0.0228).

Conclusions: Simultaneous HA resection and reconstruction is technically possible and may provide long-term survival in selected patients with locally advanced PHC.

Keywords: Hepatectomy; Hepatic artery resection; Perihilar cholangiocarcinoma.