Vascular Resection in Perihilar Cholangiocarcinoma

Abstract

Among the cholangiocarcinomas, the most common type is perihilar (phCC), accounting for approximately 60% of cases, after which are the distal and then intrahepatic forms. There is no staging system that allows for a comparison of all series and extraction of conclusions that increase the long-term survival rate of this dismal disease. The extension of the resection, which theoretically depends on the type of phCC, is not a closed subject. As surgery is the only known way to achieve a cure, many aggressive approaches have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection, or even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.

Keywords: biliary carcinoma; perihilar cholangiocarcinoma; surgery in vascular involvement; vascular invasion in perihilar cholangiocarcinoma.

Figure 1

Vascular resections options. phCCA: perihilar cholangiocarcinoma; VR: vascular resection; PV: portal vein; HA: hepatic artery; HPD: hepatopancreatectoduodenectomy; S1: segment 1; BDR: biliary duct resection.

Figure 2

Miguel Servet/Mainz Series.