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Surgical Strategies for Bismuth Type I and II Hilar Cholangiocarcinoma: Impact on Long-Term Outcomes

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The surgical approach to treat Bismuth type I and II hilar cholangiocarcinoma (HCCA) has been a topic of debate. We sought to characterize whether bile duct resection (BDR) with or without concomitant hepatic resection (HR) was associated with R0 margin status, as well as define the impact of HR+BDR versus BDR alone on long-term survival.

Methods

Patients who underwent curative-intent HR+BDR for HCCA between 2000 and 2014 were identified from a multi-institutional database. Perioperative and long-term outcomes were compared among patients who underwent BDR only, BDR+left hepatic resection (LHR), and BDR+right hepatic resection (RHR) for Bismuth type I and II HCCA.

Results

Among 257 patients with HCCA, 61 (23.7%) patients had a Bismuth type I (n=25, 41.0%) or II (n=36, 59.0%) lesion. The incidence of R0 resection after BDR only was the same as among patients after LHR and RHR (BDR 70.0% vs. BDR+LHR 71.4% vs. BDR+RHR 76.5%, p=0.891). In contrast, severe complications were more likely after LHR and RHR than BDR only (BDR 21.4% vs. BDR+LHR 60.0% and BDR+RHR 50.0%, p=0.041). Overall (median: BDR 20.9 vs. BDR+LHR 23.2 and BDR+RHR 25.0 months, p=0.213) and recurrence-free (median: BDR 13.4 vs. BDR+LHR 15.3 and BDR+RHR 25.0, p= 0.109) survival were comparable. On multivariable analysis, while CA19-9>37.0U/ml (Ref. CA19-9≤37.0U/ml, HR 3.2, 95% CI 1.1–9.4, p=0.035) and AJCC T3-T4 disease (Ref. T1-T2, HR 4.6, 95% CI 1.5–13.7, p=0.007) were associated with long-term survival, surgical approach was not (BDR+LHR: HR 1.0, 95% CI 0.5–2.2, p=0.937; BDR+RHR: HR 0.6, 95% CI 0.3–1.3, p=0.197).

Conclusion

R0 resection, overall survival, and recurrence-free survival were comparable among well-selected patients who had BDR versus BDR+HR for Bismuth type I and II HCCA.

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Author information

Author notes

  1. Xu-Feng Zhang and Nan Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xu-Feng Zhang MD, PhD & Nan Zhang MD

  2. Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, USA

    Xu-Feng Zhang MD, PhD, Diamantis I. Tsilimigras MD & Timothy M. Pawlik MD MPH PhD

  3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD

  4. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George Poultsides MD

  5. Department of Surgery, New York University, New York, NY, USA

    Ioannis Hatzaras MD

  6. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Ryan C. Fields MD

  7. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Jin He MD

  8. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA

    Charles Scoggins MD

  9. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Kamron Idrees MD

  10. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen MD

  11. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

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  1. Xu-Feng Zhang MD, PhD
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Correspondence to Timothy M. Pawlik MD MPH PhD.

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Supplementary Information

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Supplementary Figure 1

Overall survival of patients who underwent bile duct resection only versus bile duct resection and left or right hepatic resection for Bismuth type I (a) or type II (b) hilar cholangiocarcinoma. (PNG 7767 kb)

High resolution image (TIF 378 kb)

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Zhang, XF., Zhang, N., Tsilimigras, D.I. et al. Surgical Strategies for Bismuth Type I and II Hilar Cholangiocarcinoma: Impact on Long-Term Outcomes. J Gastrointest Surg 25, 3084–3091 (2021). https://doi.org/10.1007/s11605-021-05049-3

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