HILAR CHOLANGIOCARCINOMA FIFTEEN-YEAR EXPERIENCE WITH 263 PATIENTS AT A SINGLE EGYPTIAN CENTER
M. ABDEL WAHAB , O. FATHY, A. MOHAMED SULTAN, T. SALAH, M .ELSHOUBARY
A. YOSSEF ABO ELYAZID, N. ANWAR, A.SULTAN
Gastroenterology Center, Mansoura University, Mansoura, EGYPT
Background and Aim: Hilar cholangiocarcinoma (HCCC) is a challenging problem for surgeons because surgery is the only effective therapy for these patients. In this study, we review 15 years of HCCC cases and treatment.
Methodology: From January 1995 to October 2010, 263 histologically confirmed HCCC patients underwent surgical exploration at the Gastroenterology Surgical Center, Mansoura University, Egypt. Twenty cases were excluded because they were irresectable. Data were recorded for the remaining 243 cases (subjected to different types of hepatic resection), including demographics, medical history, presenting symptoms, and biochemical, radiological, and pathological parameters.
Results: The overall resectability rate of the patients studied was 92.3% (243/263). Localized resection, right hepatectomy, or left hepatectomy were completedn 30.5%, 22.6%, and 46.9% of cases, respectively, and segment one in 58%. R0 status was achieved in 49.8% of patients. The overall complication rate was 35%. Operative mortality was 6.6% (16) with a five-year survival rate of 16% for 243 cases. Recurrence occurred in 24.3% (59) and 13.6% (33) of hepatic and local resection cases, respectively. Resection margin (R0) (p<0.001), lymph node status (p<0.001) (negative), degree of differentiation (p<0.001), segment one resection (p<0.001) (positive), and status of liver (p<0.001) (normal or cirrhotic) predicted statistically higher survival (p<0.001). According to multivariate analysis, R0 lymph node status and well differentiated status. Prediction improved survival among all patients.
Conclusion: From these case studies, aggressive surgery with caudate lobe resection with normal liver parenchyma may produce better prognoses in patients with resectable HCCC.
CAUDATE LOBE RESECTION FOR PRIMARY HEPATIC TUMORS
M. ABDEL WAHAB
Gastroenterology Center of Mansoura University, Mansoura, EGYPT
Summary background data: Hepatectomy is a technically challenging surgery, and of all aspects of hepatic resection, caudate lobe resection is the most difficult. Knowledge of the anatomy of the caudate lobe is necessary to achieve safe caudate lobe resection.
Methodology: Hospital records of 54 patients, who had caudate lobe resection in our center from January 2000 to August 2007, were retrieved. The demographic data, clinicopathological features, and perioperative events were extracted and analyzed. Results Out of a total of 500 patients who had various forms of hepatic resection during the period in question, only 54 had caudate lobe resection (10.8%). Isolated caudate lobe resection (ICLR) was performed in 16 (29.6%) patients while the remainder had caudate lobe resection as a part of a major hepatectomy. Indications for hepatectomy in patients with ICLR include hepatocellular carcinoma, primary hepatic carcinoid tumor, cavernous hemangioma, and adenoma. Mean operative time for ICLR was 230±50 min while it was 240±50 min for right hepatectomy and 245±55 min for left hepatectomy. The associated mean blood loss was 1200±200, 1300±350, and 1350±350 ml, respectively. None of these were statistically significant. In patients who had ICLR, there was no mortality while three patients developed postoperative complications (bile leak in two patients and one patient with wound infection). Various forms of perioperative complications were noticed in six patients. All these patients, who also showed 7.8% mortality, had major hepatectomy.
Conclusions: Caudate lobe resection is a technically challenging procedure. Isolated caudate lobe resection is a safe procedure with good outcome in well selected patients. It is, however, associated with increased perioperative risks when associated with major hepatectomy.