Extended hepatectomy in the treatment of type III and IV hilar cholangiocarcinoma

Objective To study the effect of extended hepatectomy for hilar cholangiocarcinoma (HCCA) of the Bismuth-Corlette type Ⅲ and Ⅳ. Methods The clinical data of 73 patients with HCCA of the Bismuth-Corlette type Ⅲ and Ⅳ treated in our department from January, 2008 to June, 2016 were analyzed retrospectively. The extended hepatectomy group of patients consisted of 29 patients who underwent hepatectomy with half or more than half of the liver removed or/and combined with hepatic caudate lobectomy. The limited hepatectomy group consisted of 44 patients who underwent non-anatomical hepatectomy around the hepatic hilar region. Results Compared with the limited hepatectomy group, patients in the extended hepatectomy group had significantly longer operations with significantly more intraoperative blood loss. However, the complication rate was significantly lower than that of the limited hepatectomy group. There was no perioperative death in the extended hepatectomy group, while 3 perioperative deaths occurred in the limited hepatectomy group. The R0 resection rate was 93.1% (27 of 29) for the extended hepatectomy group, while it was 54.6% (24 of 44) for the limited hepatectomy group (P<0.05). The 1-, 3- and 5-year survival rates or the extended hepatectomy group were 81.4%, 51.4% and 19.3%, respectively while the corresponding rates for the limited hepatectomy group were 70.5%, 24.4% and 8.7%, respectively (P<0.05). Conclusions After adequate preoperative radiological assessments on tumor resectability, and the residual liver volumes, with preoperative biliary drainage to improve liver function, extended hepatectomy effectively increased R0 resection and survival rates with improved prognosis for patients with HCCA of Bismuth-Corlette type Ⅲ and Ⅳ. Key words: Hilar cholangiocarcinoma; Surgical therapy; Extended hepatectomy; Limited hepatectomy; Prognosis