Role of Caudate Lobectomy in Type IIIA and IIIB Hilar Cholangiocarcinoma: A 15-year Experience in a Tertiary Institution

• Published in: World journal of surgery Vol. 36; no. 5; pp. 1112 - 1121
• Main Authors: Kow, Alfred Wei-Chieh, Wook, Choi Dong, Song, Sun Choon, Kim, Woo Seok, Kim, Min Jung, Park, Hyo Jun, Heo, Jin Soek, Choi, Seong Ho
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-05-2012; Springer‐Verlag
• Subjects: Abdominal Surgery; Bile Duct; Cardiac Surgery; General Surgery; Liver Resection; Medicine; Medicine & Public Health; Overall Survival; Portal Vein Embolization; Surgery; Thoracic Surgery; Type IIIA; Vascular Surgery; Bile Duct; Liver Resection; Type IIIA; Portal Vein Embolization; Overall Survival
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-012-1497-0

Background
Concomitant liver resection for type III hilar cholangiocarcinoma could improve the R0 resection rate and long-term outcome. In the present study, we examine the specific role of caudate lobectomy in liver resection for type III
A
and III
B
hilar cholangiocarcinoma and the prognostic factors for survival in this group of patients.
Methods
We reviewed all patients with type III
A
and III
B
hilar cholangiocarcinoma who underwent liver resection in Samsung Medical Center from January 1995 to July 2010. Patients were divided into those with and without caudate lobectomy (CL). The log rank test and Cox regression analysis were employed to investigate for prognostic factors of survival.
Results
There were 127 patients in this cohort, 57 without CL (44.9%) and 70 with CL (55.1%). The demographics and symptoms of presentation were comparable. The median preoperative bilirubin level was significantly higher in the group undergoing CL (
p
 = 0.017). Patients with CL had a significantly better overall survival (OS) (CL: 64.0 months vs without CL: 34.6 months) (
p
 = 0.010) and disease-free survival (DFS) (CL: 40.5 months vs without CL: 27.0 months) (
p
 = 0.031). Multivariate analysis showed that presence of symptoms (
p
 = 0.025) and positive lymph node (LN) metastasis (
p
 < 0.001) were negative prognostic factors for OS. Furthermore, multivariate analysis for DFS found that caudate lobectomy (
p
 = 0.016) and positive LN metastasis (
p
 = 0.001) were positive and negative prognostic factors, respectively.
Conclusions
Caudate lobectomy contributed to improvement of DFS and OS in type III hilar cholangiocarcinoma. Other prognostic factors include positive LN metastasis and presence of symptoms.