• OLT
• cholangiocarcinoma
• extrahepatic cholangiocarcinoma (eCCA)
• intrahepatic cholangiocarcinoma (iCCA)
• liver resection and PVE
• liver transplantation

• Japan
• National Clinical Database
• biliary cancer
• left trisectionectomy
• morbidity

• Humans
• Japan/epidemiology
• Retrospective Studies
• Blood Loss, Surgical
• Biliary Tract Neoplasms/epidemiology
• Biliary Tract Neoplasms/surgery
• Morbidity
• Postoperative Complications/epidemiology

• Left hepatic trisectionectomy
• Liver neoplasms
• Major hepatectomy
• Morbidity
• Survival rate

• Immunotherapy
• intrahepatic cholangiocarcinoma
• locoregional therapy
• lymphadenectomy
• surgical resection
• target therapy
• transplantation

Hepatectomy with vascular resection (VR) for perihilar cholangiocarcinoma (PHCC) is a challenging procedure. However, only a few reports on this procedure have been published and its clinical significance has not been fully evaluated.

Patients undergoing surgical resection for PHCC from 2002–2017 were studied. The surgical outcomes of VR and non-VR groups were compared.

Some 238 patients were included. VR was performed in 85 patients. The resected vessels were hepatic artery alone (31 patients), portal vein alone (37 patients) or both (17 patients). The morbidity rates were almost the same in the VR (49.4 per cent) and non-VR (43.8 per cent) groups (P = 0.404). The mortality rates of VR (3.5 per cent) and non-VR (3.3 per cent) were also comparable (P > 0.999). The median survival time (MST) was 45 months in the non-VR group and 36 months in VR group (P = 0.124). Among patients in whom tumour involvement was suspected on preoperative imaging and whose carbohydrate antigen 19-9 (CA19-9) value was 37 U/ml or less, MST in the VR group was significantly longer than that in the non-VR group (50 versus 34 months, P = 0.017). In contrast, when the CA19-9 value was greater than 37 U/ml, MST of the VR and non-VR groups was comparable (28 versus 29 months, P = 0.520).

Hepatectomy with VR for PHCC can be performed in a highly specialized hepatobiliary centre with equivalent short- and long-term outcomes to hepatectomy without VR.

• Hilar cholangiocarcinoma
• Left-side hepatectomy
• Meta-analysis
• Perihilar cholangiocarcinoma
• Right-side hepatectomy

• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic/surgery
• Cholangiocarcinoma/surgery
• Hepatectomy/adverse effects
• Humans
• Klatskin Tumor/surgery
• Prognosis
• Retrospective Studies
• Treatment Outcome

• No.81874228 National Natural Science Foundation of China
• JBZX-202004 Grant from Health Commission of Zhejiang Province

This study was conducted to evaluate the prognostic values of the 7th and 8th American Joint Committee on Cancer (AJCC) staging systems for patients with resected perihilar cholangiocarcinoma (PHCC).

A total of 348 patients who underwent major hepatectomy for PHCC between 2008 and 2015 were identified from a single center. Overall survival (OS) was estimated using the Kaplan-Meier method and compared across stage groups with the log-rank test. The concordance index was used to evaluate the prognostic predictability of the 8th AJCC staging system compared with that of the 7th.

In the 8th edition, the stratification of each group of T classification improved compared to that in the 7th, as the survival rate of T4 decreased (T2, 31.2%; T3, 13.9%; T4, 15.1%; T1-T2, p=0.260; T2-T3, p=0.001; T3-T4, p=0.996). Both editions showed significant survival differences between each N category, except between N1 and N2 (p=0.063) in 7th edition. Differences of point estimates between the 8th and 7th T and N classification and overall stages were +0.028, +0.006, and +0.039, respectively (T, p=0.005; N, p=0.115; overall stage, p=0.005). In multivariable analysis, posthepatectomy liver failure, T category, N category, distant metastasis, histologic differentiation, intraoperative transfusion, and resection margin status were associated with OS.

The prognostic predictability of 8th AJCC staging for PHCC improved slightly, with statistical significance, compared to the 7th edition, but its overall performance is still unsatisfactory.

• Perihilar cholangiocarcinoma
• Prognosis
• Stage
• Survival

• Case report
• Left-sided gallbladder
• Perihilar cholangiocarcinoma
• Right-sided round ligament

• colorectal liver metastases
• liver resection
• right hepatic trisectionectomy

•

In case of cholangiocarcinoma invading hilar vessels, adequate simulations and expert skills are required to achieve R0 resection.

The present case report demonstrated the successfully radical operation (R0) for the highly advanced cholangiocarcinoma involving hilar hepatic arteries and portal vein, The careful preoperative diagnosis to define the adequate resection area and the expert operation was achieved without postoperative severe complications.

A 55-year-old male was admitted to our hospital with obstructive jaundice, and the perihilar cholangiocarcinoma (PC) was found. At the time of finding PC, enhanced computed tomography showed the widely extension and involved the surrounding right hepatic artery (RHA) and bilateral portal veins (PV). According to extension of PC, left trisectionectomy combined resection of RHA and PV trunk was scheduled. By supporting plastic surgeon’s procedure, the scheduled R0 operation could be achieved and the patient was discharged without any severe complication but delayed intrahepatic abscess formation. After abscess drainage, he could immediately recovered and tumor relapse was not observed for a couple of months. By carefully preoperative examination, a complicated operation was successfully completed.

The major hepatectomy with arterio-portal resections and anastomosis for advanced has been challenged at the high-volume center and the improvement of survival seemed to be obtained and, however, operative risk is still remained. This operation could be achieved by the expert surgeons under precise planning or management.

The role of HBP surgeons is to challenge aggressive surgery even for patients with highly advanced local extension of PC.

• Careful managements
• Combined vascular resection
• Left trisectionectomy

• Extended hepatectomy
• Laparoscopic liver resection
• Trisectionectomy

• Adult
• Aged
• Aged, 80 and over
• Blood Loss, Surgical/statistics & numerical data
• Female
• Hepatectomy/methods
• Humans
• Laparoscopy
• Length of Stay/statistics & numerical data
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Young Adult

• 3D images
• Central bisectionectomy
• Left trisectionectomy
• Right hepatic vein
• Right posterior hepatic artery
• Ventral branches of segment VI portal vein

• Caudate lobe
• Couinaud's segment
• Donor hepatectomy
• Glissonean approach
• Indocyanine green
• Segmentectomy of the liver

AIM: To examine survival outcomes of perihilar cholangiocarcinoma (PCCA) resection including mortality, morbidity and prognostic factors.

METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011.

RESULTS: There were 29 (19%) cases of intrahepatic CCA that involved hilar and 124 (81%) with hilar bile-duct cancer. R0 resection was carried out on 66 (43.1%) patients of whom 50 (32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6% (95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1.

CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.

• Perihilar cholangiocarcinoma
• Thailand
• Curative resection
• Five-year survival
• Prognostic factors

Cholangiocarcinoma is a malignant tumor of the biliary system that can be classified into intrahepatic (iCCA), perihiliar (phCCA) and distal. Initial experiences with orthotopic liver transplantation (OLT) for patients with iCCA and phCCA had very poor results and this treatment strategy was abandoned. In the last decade, thanks to a strict selection process and a neoadjuvant chemoradiation protocol, the results of OLT for patients with non-resectable phCCA have been shown to be excellent and this strategy has been extended worldwide in selected transplant centers. Intrahepatic cholangiocarcinoma is a growing disease in most countries and can be diagnosed both in cirrhotic and in non-cirrhotic livers. Even though OLT is contraindicated in most centers, recent investigations analyzing patients that were transplanted with a misdiagnosis of HCC and were found to have an iCCA have shown encouraging results. There is some information suggesting that patients with early stages of the disease could benefit from OLT. In this review we analyze the current state-of-the-art of OLT for cholangiocarcinoma as well as the new insights and future perspectives.

• Orthotopic liver transplantation
• Perihiliar cholangiocarcinoma
• Intrahepatic cholangiocarcinoma

• clinical < hepatology
• hepatocellular carcinoma
• liver surgery < hepatology
• treatment < hepatology

• cholangiocarcinoma
• magnetic resonance imaging
• primary sclerosing cholangitis
• resectability
• staging