Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution

Ryota Higuchi; Takehiro Ota; Takehisa Yazawa; Hideki Kajiyama; Tatsuo Araida; Toru Furukawa; Tatsuya Yoshikawa; Ken Takasaki; Masakazu Yamamoto

doi:10.1007/s00595-015-1119-1

Improved surgical outcomes for hilar cholangiocarcinoma: changes in surgical procedures and related outcomes based on 40 years of experience at a single institution

Surg Today. 2016 Jan;46(1):74-83. doi: 10.1007/s00595-015-1119-1. Epub 2015 Feb 5.

Authors

Ryota Higuchi¹, Takehiro Ota², Takehisa Yazawa¹, Hideki Kajiyama¹, Tatsuo Araida³, Toru Furukawa⁴, Tatsuya Yoshikawa¹, Ken Takasaki¹, Masakazu Yamamoto⁵

Affiliations

¹ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
² Ebara Hospital, Tokyo, Japan.
³ Division of Gastroenterological Surgery, Department of Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan.
⁴ Department of Pathology, and International Research and Educational Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan.
⁵ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. yamamoto@ige.twmu.ac.jp.

PMID: 25649537
DOI: 10.1007/s00595-015-1119-1

Abstract

Purpose: This study aimed to examine the changes in procedures for hilar cholangiocarcinoma (HC) surgery and patient survival following HC surgery over a 40-year period.

Methods: Between 1974 and 2014, 239 consecutive patients underwent surgery for HC. The changes in perioperative therapy and short- and long-term surgical outcomes were evaluated.

Results: The rates of major hepatectomy (in particular, right hepatectomy) and R0 resection significantly increased. Blood loss, transfusion rate, morbidity, and surgical mortality all significantly decreased. The 5-year disease-specific survival was 9.29 % (n = 38) in 1974-1988, 41.1 % (n = 88) in 1989-2003 and 55.6 % (n = 57) in 2004-2008 (p = 0.0001: 1974-1988 vs 1989-2003, p < 0.0001:1974-1988 vs 2004-2008, p = 0.076: 1989-2003 vs 2004-2008). According to a multivariate analysis, Bismuth classification IV (HR vs I, 2.86), period 1989-2003 (HR vs 1974-1988, 0.31), 2004-2008 (HR vs 1974-1988, 0.26), and R1 or R2 resection (HR vs R0, 2.22) were independent prognostic factors.

Conclusion: The surgical outcomes for HC over the 40-year period clearly improved as a result of aggressive surgery and progress in surgical techniques, perioperative management, and diagnostic tools.

Keywords: Bile duct cancer; Cholangiocarcinoma; Hepatectomy; Hilar; Surgery; Survival.