Surgical treatment of perihilar cholangiocarcinoma: 10-year experience at a single institution
Abstract
Background: Our study evaluates surgical outcomes of patients treated for perihilar cholangiocarcinoma in a single institution and demonstrates postoperative (90 days) morbidity and mortality rates and potential prognostic factors associated with complications.
Methods: Medical records of all patients with a diagnosis of perihilar cholangiocarcinoma (pCC) between 2007 and 2017 who underwent a surgical procedure at the University hospital centre Zagreb, were retrospectively evaluated. Statistical analysis to determine predictors of postoperative mortality was performed using the Chi-square test and Fisher exact probability test where appropriate.
Results: Out of 52 surgically treated patients, 43 underwent radical and 9 palliative procedures. Hilar resection and hilar resection along with right hepatectomy were the most commonly performed procedures in 34 radically treated patients. Overall morbidity and mortality rates were 46% and 5.7%, respectively. Significantly higher morbidity rate was observed in a group of patient with untreated preoperative jaundice and in those aged 70 and over.
Conclusion: Current guidelines favor extension of radicality in treatment of pCC by performing left or right hepatectomy in addition to hilar resection. This may increase R0 resection rates and prolong disease free survival. Our experience shows similar mortality/morbidity rates as reported in other centers and confirms that in selected patients, concomitant hepatectomy for perihilar pCC is a safe and feasible surgical strategy.
Downloads
References
Zhang W, Yan LN. Perihilar cholangiocarcinoma: Current therapy. World J Gastrointest Pathophysiol. 2014;5(3):344-54.
Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BS J, Youssef BA M, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 225 patients with perihilar cholangiocarcinoma. Ann Surg. 2001;234:507–517; discussion 517-519.
Ramos E. Principles of surgical resection in perihilar cholangiocarcinoma. World J Gastrointest Oncol. 2013;5:139–146.
Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for perihilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg. 1999;230:663–671.
Hu HJ, Mao H, Shrestha A, et al. Prognostic factors and long-term outcomes of perihilar cholangiocarcinoma: A single-institution experience in China. World J Gastroenterol. 2016;22(8):2601-10.
Kow AW, Wook CD, Song SC, Kim WS, Kim MJ, Park HJ, Heo JS, Choi SH. Role of caudate lobectomy in type III A and III B perihilar cholangiocarcinoma: a 15-year experience in a tertiary institution. World J Surg. 2012;36:1112–1121.
Lillemoe KD, Cameron JL. Surgery for perihilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobiliary Pancreat Surg. 2000;7:115–121.
Mantel HT, Westerkamp AC, Adam R, et al. Strict Selection Alone of Patients Undergoing Liver Transplantation for Perihilar Cholangiocarcinoma Is Associated with Improved Survival. PLoS One. 2016;11(6):e0156127. Published 2016 Jun 8. doi:10.1371/journal.pone.0156127
Copyright (c) 2019 Acta Chirurgica Croatica

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby authorize the Acta Chirurgica Croatica (ACC) to publish their work.
The authors are aware that although ACC is Open Access journal, the copyright of all material published is vested in ACC. Open access articles are freely available to read, download, and share from the time of publication under the terms of the Creative Commons License Attribution ‐ NonCommerical No Derivative (CC BY‐NC‐ND) license. This license does not permit reuse for any commercial purposes nor does it cover the reuse or modification of individual elements of the work (such as figures, tables, etc.) in the creation of derivative works without specific permission of ACC and appropriate acknowledgment of its source. The authors permit ACC to allow third parties to copy any part of the work without asking for permission, provided that the reference to the source is given and that this is not done for commercial purposes. Except for copyright, other proprietary rights related to the work (e.g., patent or other rights to any process or procedure) shall be retained by the author. To reproduce any text, figures, tables, or illustrations from this work in future works of their own, the author must obtain written permission from ACC.
Each of the author(s) hereby also grants permission to ACC to use such author’s name and likeness in connection with any past, present or future promotional activity by ACC, including, but not limited to, promotions for upcoming issues or publications, circulation solicitations, advertising or other publications in connection with ACC. Also, each of the author(s) hereby grants permission to ACC to use the manuscript in editorial research related to the improvement of editorial conduct, decision making, and issues related to peer review.
Each of the author(s) hereby releases and shall indemnify and hold harmless ACC and its successors, assigns, licensees, officers, directors, employees, and their respective heirs and representatives from and against any and all liabilities, losses, damages and expenses arising out of any claims of any kind that may be asserted against any of them based in whole or in part on any breach of the author(s)’ representations or warranties herein or in the work or anything contained in the work, including but not limited to any claims for copyright infringement or violation of any rights of privacy or publicity.