Evaluation of Different Efficiency Methods of Surgical Treatment in Patients with Liver Hilus Tumors
Surgical treatment of the hilar cholangiocarcinoma (CCC) yields the only opportunity for long-term survival. Radical margin-free resection is challenging due to tumor localization, local spread and invasion of the vascular structures. Aim. The aim of our study is to evaluate different types of surgical treatment of hilar CCC. Material and methods. From January 2008 to April 2013 152 patients with different types of hilar CCC were admitted to our center. 39 (25.7%) patients underwent radical surgical resection, including two orthotopic liver transplantation (OLT). In 113 (74.3%) cases palliative biliary drainage was performed. Caudatectomy was performed in 100%, and portal vein was resected in 45% of cases. Results. Abdominal complications developed in 16 (41%) patients, 43% out of them were biliary events (biliary peritonitis, fistula). After OLT no complication were revealed and 3 years survival rate was 50%. In case of palliative treatment 1-year survival rate was 11%. 3-year survival after liver resection with portal vein resection was significantly higher then without portal vein resection (36% and 22% correspondingly, p = 0,04). Disease free survival after hepatopancreatectomy was only 8 months. Conclusion. Hemihepatectomy with caudatectomy, resection of extrahepatic bile duct, lymphadenectomy and portal vein resection allows the best results and long-term survival in surgical treatment of the hilar cholangiocarcinoma. Hepatopancreatectomy is an applicable option in treatment of hilar CCC but tumor extension up to pancreatic head reduce disease free survival and requires better patient selection in future. Liver transplantation in treatment of HCC is still challenging question in the setting of absence of pre-transplant chemoradiation.