Does portal vein resection with hepatectomy improve survival in locally advanced hilar cholangiocarcinoma?

摘要

BACKGROUND/AIMS: Although portal vein resection (PVR) can increase the respectability and curability in locally invading hilar cholangiocarcinoma, there are still controversies in regards to the balance between the risk and the benefit. The present study retrospectively assessed the safety and survival impact of PVR in locally advanced hilar cholangiocarcinoma (HCCA). METHODOLOGY: 259 patients undergoing surgical resection for HCCA between June 1989 and June 2005 were divided into two groups, 51 who underwent PVR (PVR+) and 208 who did not (PVR-). We compared survival and clinicopathological data between these two groups. RESULTS: The 5-yr survival rate of PVR+ group (22.8%) was significantly lower than one of PVR- group (30.9%), but 7 of 51 patients (13.7%) have survived more than 5 yr. Five operative mortalities (9.8%) occurred in PVR+ group, but only 1 of 5 mortalities was directly related to PVR. The morbidity rate and postoperative liver function did not differ between two groups. In the PVR+ group, 28 (54.9%) had actual tumor invasion into the portal vein, but tumor invasion demonstrated no effect on survival. CONCLUSIONS: Although PVR + group demonstrated low survival rate than PVR- group, PVR can offer long-term survival in more than 1 of 10 locally advanced HCCA. However, operative mortality should be lowered to apply PVR in hepatectomy for HCCA.