Surgical Treatment of Hilar Cholangiocarcinoma with Invasion into the Portal Vein

O.G. Kotenko, A.O. Popov, A.A. Korshak, A.V. Grinenko, A.V. Gusev, D.A. Fedorov, M.S. Grigoryan

Abstract


Treatment of cholangiocarcinoma of bile duct confluence remains one of the most difficult and unresolved problems of modern surgical hepatology. From 2003 to May 2013 in National institute of surgery and transplantology named after A.A. Shalimov there were carried out 181 surgical intervention for cholangiocarcinoma of bile duct confluence.
The present study includes the outcomes of surgical treatment of 126 patients who underwent extensive resection of the liver with portal vein grafting or without it. All patients who underwent radical surgery are divided into groups according to the tumor invasion into the portal vein. Group 1 included 72 (57 %) patients with hilar cholangiocarcinoma who were identified non-tumor invasion into portal vein confluence. These patients completed extensive liver resection in combination with resection and plastics of the portal vein. Group 2 were 54 (43 %) patients with liver resections without vascular plasticity. This study showed no significant difference in the early postoperative mortality and five-year survival rate in patients with invasion into the portal vein confluence and without it. Recently, there are studies on the need to expand the extent of surgery for hilar cholangiocarcinoma by performing a combined en block resection, including right trisectioectomy, resection of the extrahepatic bile ducts, resection of the portal vein and the hepatic artery. This approach allows us to expand the indications in patients with Klatskin tumors and to achieve 58% five-year survival rate.


Keywords


cholangiocarcinoma; liver resection

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DOI: https://doi.org/10.22141/1997-2938.3.22.2013.87312

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