Detailed Abstract
[Oral Presentation 1 - Biliary & Pancreas (Biliary Disease/Surgery)]
[OP 1-8] The significance of vascular combined resection and reconstruction for locally advanced perihilar cholangiocarcinoma
Ryusei MATSUYAMA*1 , Yasuhiro YABUSHITA1 , Kizuki YUZA1 , Tomoaki TAKAHASHI1 , Kentaro MIYAKE1 , Yu SAWADA1 , Yuki HOMMA1 , Itaru ENDO1
1 Gastroenterological Surgery, Yokohama City University, JAPAN
Background : The aim of this study is to evaluate the safety and usefulness of vascular reconstruction (VR) to achieve a curative resection for perihilar cholangiocarcinoma (PHC).
Methods : Of 293 patients of PHC resected in our department from 1992 to 2020, 201 patients underwent hepatectomy excluding HPD. Patients were divided into 3 groups: VR(-) without revascularization: 82 cases, VR-PV with reconstruction of portal vein only: 75 cases, VR-A with reconstruction of hepatic artery: 44 cases (including 30 cases of PV+HA).
Results : Postoperative complications were significantly higher in the VR-A: 39 (48%) in the VR (-), 30 (40%) in the VR-PV, and 31 (71%) (p=0.002). R0 resection was similar in the revascularization groups: 63 (77%) in the VR (-), 55 (73%) in the VR-PV, and 35 (80%) in the VR-A. Pathologically positive lymph nodes were significantly higher in the revascularization group: 22 (27%) in the VR (-), 37 (49%) in the VR-PV, and 25 (57%) in the VR-A (p=0.001). 5-year survival rates were 50% in the VR (-), 38% in the VR-PV, and 25% in the VR-A. The MST for VR-A patients who did not receive adjuvant therapy was 13.3 months, which was significantly worse than that for those who had received adjuvant therapy (30.2 months) (p = 0.001).
Conclusions : VR for PHC is a useful technique to achieve a high R0 resection rate even in advanced cases. However, complications are high, especially in cases of arterial reconstruction, and multidisciplinary treatment is considered essential to improve long-term survival.
Methods : Of 293 patients of PHC resected in our department from 1992 to 2020, 201 patients underwent hepatectomy excluding HPD. Patients were divided into 3 groups: VR(-) without revascularization: 82 cases, VR-PV with reconstruction of portal vein only: 75 cases, VR-A with reconstruction of hepatic artery: 44 cases (including 30 cases of PV+HA).
Results : Postoperative complications were significantly higher in the VR-A: 39 (48%) in the VR (-), 30 (40%) in the VR-PV, and 31 (71%) (p=0.002). R0 resection was similar in the revascularization groups: 63 (77%) in the VR (-), 55 (73%) in the VR-PV, and 35 (80%) in the VR-A. Pathologically positive lymph nodes were significantly higher in the revascularization group: 22 (27%) in the VR (-), 37 (49%) in the VR-PV, and 25 (57%) in the VR-A (p=0.001). 5-year survival rates were 50% in the VR (-), 38% in the VR-PV, and 25% in the VR-A. The MST for VR-A patients who did not receive adjuvant therapy was 13.3 months, which was significantly worse than that for those who had received adjuvant therapy (30.2 months) (p = 0.001).
Conclusions : VR for PHC is a useful technique to achieve a high R0 resection rate even in advanced cases. However, complications are high, especially in cases of arterial reconstruction, and multidisciplinary treatment is considered essential to improve long-term survival.
SESSION
Oral Presentation 1
Room A 3/23/2023 1:50 PM - 2:50 PM