Surgical management of hilar cholangiocarcinoma: the Nagoya experience

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Abstract
Although many articles have been published regarding hilar cholangiocarcinoma, the resection rate of this intractable disease is still low in most centres. Aggressive surgery to achieve a curative resection can offer a better survival than conservative therapy [ 1 x [1] Tashiro, S., Tsuji, T., Kanemitsu, K., Kamimoto, Y., Hiraoka, T., and Miyauchi, Y. Prolongation of survival for carcinoma at the hepatic duct confluence. Surgery. 1993; 113: 270–278 PubMed | Google Scholar See all References , 2 x [2] Launois, B., Terblanche, J., Lakehal, M., Catheline, J.M., Bardaxoglou, E., and Landen, S. Proximal bile duct cancer: high resectability rate and 5‐year survival. Ann Surg. 1999; 230: 266–275 Crossref | PubMed | Scopus (140) | Google Scholar See all References , 3 x [3] Tsao, J.I., Nimura, Y., Kamiya, J., Hayakawa, N., Kondo, S., and Nagino, M. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience. Ann Surg. 2000; 232: 166–174 Crossref | PubMed | Scopus (208) | Google Scholar See all References ]. Precise preoperative evaluation of tumour extent is mandatory to plan a curative resection, and hepatectomy with caudate lobe resection is necessary in most cases [ 4 x [4] Nimura, Y., Hayakawa, N., Kamiya, J., Kondo, S., and Shionoya, S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg. 1990; 14: 535–544 Crossref | PubMed | Scopus (404) | Google Scholar See all References 4 ]. Concomitant portal vein resection and reconstruction have been applied to increase the resection rate and to prolong patients’ survival [ 1 x [1] Tashiro, S., Tsuji, T., Kanemitsu, K., Kamimoto, Y., Hiraoka, T., and Miyauchi, Y. Prolongation of survival for carcinoma at the hepatic duct confluence. Surgery. 1993; 113: 270–278 PubMed | Google Scholar See all References , 2 x [2] Launois, B., Terblanche, J., Lakehal, M., Catheline, J.M., Bardaxoglou, E., and Landen, S. Proximal bile duct cancer: high resectability rate and 5‐year survival. Ann Surg. 1999; 230: 266–275 Crossref | PubMed | Scopus (140) | Google Scholar See all References ], [ 5 x [5] Nimura, Y., Hayakawa, N., Kamiya, J., Maeda, S., Kondo, S., and Yasui, A. Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg. 1991; 78: 727–731 Crossref | PubMed | Scopus (177) | Google Scholar See all References , 6 x [6] Sakaguchi, S. and Nakamura, S. Surgery of the portal vein in resection of cancer of the hepatic hilus. Surgery. 1986; 99: 344–349 PubMed | Google Scholar See all References , 7 x [7] Munoz, L., Roayaie, S., Maman, D., Fishbein, T., Sheiner, P., and Emre, S. Hilar cholangiocarcinoma involving the portal vein bifurcation: long‐term results after resection. J Hepatobiliary Pancreat Surg. 2002; 9: 237–241 Crossref | PubMed | Scopus (49) | Google Scholar See all References ]. Still controversial, however, is the issue of combining pancreatoduodenectomy and major liver resection in the treatment of hilar cholangiocarcinoma [ 8 x [8] Nimura, Y., Hayakawa, N., Kamiya, J., Maeda, S., Kondo, S., and Yasui, A. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991; 38: 170–175 PubMed | Google Scholar See all References 8 ]. We have treated patients with hilar cholangiocarcinoma following an aggressive strategy and herein describe the results of our 27 years of experience at the Nagoya University Hospital.