CHOLANGIOCARCINOMA: RESULTS OF SURGICAL TREATMENT
Introduction: Surgical treatment of cholangiocarcinomas is accompanied by a great number of post-operative complications and high mortality. This is due to obstructive jaundice and insufficient liver parenchyma remaining after its extensive resection. The development of irreversible hepatic decompensation in the post-operative period becomes the main cause of unsatisfactory treatment outcomes. Research aim: to improve the outcomes of the surgical treatment of cholangiocarcinomas using miniinvasive technologies. Materials and methods: Treatment outcomes for 72 patients with cholangiocarcinomas were analyzed. All patients underwent radical surgeries. The amount and type of operative treatment depended on the extent, localization of the tumor, and the Bismuth-Corlette classification. Results: Percutaneous transhepatic biliary drainage was performed for the decompression of bile ducts in all patients of Group 1 (n=39, (54.1%)) as pre-operative preparation for the radical surgery. Embolization of portal vein branches was performed in 4 patients (10.2%) to increase the volume of the remaining liver parenchyma. Patients from Group 2 (n=33, (45.9%)) were prepared for radical surgeries through the application of biliodigestive anastomosis, or through the drainage of bile ducts or of the bladder using laparotomy. Isolated resections of bile ducts were performed in type I and II tumors. Liver resections up to extended hemihepatectomy were performed in type III and IV tumors. Total caudal lobectomy and lymph node dissection of the hepatoduodenal ligament was considered mandatory. Resection of the portal vein was performed in 8 (11.1%) patients. Circular resection was performed in 3 (4.1%) patients, and lateral resection in 5 (6.9%) patients. Conclusions: Mini-invasive pre-operative preparation reduces the number of complications after radical surgeries from 39.4% to 17.9%, and the mortality rate from 15.2% to 7.7% as compared to patients who previously underwent operations using classical methods.