A Clinicopathological Study of Hilar Cholangiocarcinoma

Surgical Problems in Curative Resection

Abstract

Nineteen resected hilar cholangiocarcinomas were analyzed clinicopathologically to elucidate the surgical problems in curative resection for hilar cholangiocarcinoma. Histological lymph node metastases were within group 2 lymph nodes except for 1 patient. Cancer invasion to the portal vein was histologically positive in 4 of 7 patients with portal vein resection. Two of 3 other patients with negative invasion showed cancer invasion close to the wall of the portal vein. Quadrate lobe invasion was found in 6 of 10 patients (60.0%). Fourteen of 16 patients (87.5%) with histologically positive cancer invasion at the wedge of section were judged to be excisional wedge (ew) positive. Ten patients (55.6%) including 4 patients of portal vein resection were ew positive for large vessels in the hepatoduodenal ligament. Eight patients (44.4%) were ew positive at the hepatic side. Recurrent patterns were accompanied by local recurrence in all patients of primary death. The above results indicate that portal vein resection is thought to be necessary to obtain curative resection for hilar cholangiocarcinoma, but it is necessary to obtain an ew negative state for the hepatic artery from now on. Moreover, the pre and intraoperative closer examination in cancer invasion and quadrate lobe resection is suggested to be necessary to obtain an ew negative state at the hepatic side.