Ann Hepatobiliary Pancreat Surg.  2021 May;25(2):221-229. 10.14701/ahbps.2021.25.2.221.

The impact of portal vein resection on outcome of hilar cholangiocarcinoma

• Kim KB
• Choi DW
• Heo JS
• Han IW
• Shin SH
• You Y
• Park DJ

• KMID: 2516243
• DOI: http://doi.org/10.14701/ahbps.2021.25.2.221

Abstract

Backgrounds/Aims
Portal vein resection (PVR) with major hepatic resection can increase the rate of curative resection for hilar cholangiocarcinoma (HC). However, the oncologic role and safety of PVR is still debatable. This study aims to analyze PVR in terms of safety and therapeutic effectiveness.
Methods
We retrospectively analyzed 235 patients who had undergone major hepatic resection for HC with curative intent, including patients with PVR (PVR, n=35) consisting of PV invasion (PVR-A, n=9), No PV invasion (PVR-B, n=26); and patients without PVR (No PVR, n=200).
Results
There was no significant difference in the 30-day mortality or postoperative morbidity between PVR and No PVR (2.9% vs. 1.0%; p=0.394 and 34.3% vs. 35.0%; p=0.875). The rate of advanced HC (T3: 40% vs. 12%; p＜0.001 and nodal metastasis: 60% vs. 28%; p＜0.001) was higher in PVR compared to No PVR. There was no significant difference in the 5-year overall survival rates and disease-free survival between PVR-A vs. PVR-B vs. No PVR. In multivariate analysis, estimated blood loss ＞600 ml (p=0.010), T3 diseases (p=0.001), nodal metastasis (p=0.001) and poor differentiation (p=0.002) were identified as independent risk factors for survival.
Conclusions
PVR does not increase postoperative mortality or morbidity. It showed a similar oncologic outcome, despite a more advanced disease state in patients with HC. Given these findings, PVR should be actively performed if necessary, after careful patient selection.

Keyword

Hilar cholanagiocarcinoma; Portal vein resection; Mortality; Morbidity; Oncologic outcome

Figure

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  Fig. 1 Patients selection.

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  Fig. 2 Kaplan-Meier survival analysis (A) 5-year overall survival rate (OSR) of PVR and No PVR (B) 5-year disease-free survival rates (DFS) of PVR and No PVR (C) 5-year OSR for PVR-A, PVR-B and No PVR (D) 5-year DFS for PVR-A, PVR-B and No PVR.

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