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Survival outcome of surgical resection compared to non-resection for Bismuth type IV perihilar cholangiocarcinoma

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Author(s)
Jinmok BaeDong Woo ShinKwang Bum ChoKeun Soo AhnTae-Seok KimYong Hoon KimKoo Jeong Kang
Keimyung Author(s)
Cho, Kwang BumAhn, Keun SooKim, Tae SeokKim, Yong HoonKang, Koo Jeong
Department
Dept. of Internal Medicine (내과학)
Dept. of Surgery (외과학)
Journal Title
Langenbecks Arch Surg
Issued Date
2023
Volume
408
Issue
1
Keyword
Type IV hilar cholangiocarcinomaoverall survivalsurgical resection
Abstract
Background/objectives:
Bismuth type IV perihilar cholangiocarcinoma has been considered an unresectable disease. The aim of the study was to assess whether the surgical resection of type IV perihilar cholangiocarcinoma was associated with better survival rates.

Methods:
The data of 117 patients diagnosed with type IV perihilar cholangiocarcinoma at Keimyung University Dongsan Hospital from 2005 to 2020 were retrospectively reviewed. The Bismuth type was assigned based on the patient's radiological imaging findings. The primary outcomes were the surgical results and median overall survival.

Results:
The demographic characteristics of the 117 patients with type IV perihilar cholangiocarcinoma were comparable between the surgical resection and non-resection groups. Thirty-two (27.4%) patients underwent surgical resections. A left hepatectomy was performed in 16 patients, right hepatectomy in 13 patients, and a central bi-sectionectomy in three patients. The remaining 85 patients received non-surgical treatments. Thirteen (10.9%) received palliative chemotherapy, and 72 (60.5%) patients received conservative treatment including biliary drainage. The patients in the resection group showed significantly longer median overall survival than the patients in the non-resection group (32.4 vs 16.0 months; P = 0.002), even though the positive resection margin rate was high (62.5%). Surgical complications occurred in 15 (46.9%) patients. Complications of Clavien-Dindo classification grade III or higher occurred in 13 (40.6%) patients and grade V in two patients (6.3%).

Conclusion:
Surgical resection for Bismuth type IV perihilar cholangiocarcinoma is technically demanding. The survival of the resection group was significantly better than that of the non-resection group. The resection of selected patients achieved a curative goal with acceptable postoperative morbidity, although the microscopically positive resection margin rate was high.
Keimyung Author(s)(Kor)
조광범
안근수
김태석
김용훈
강구정
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1435-2451
Source
https://link.springer.com/article/10.1007/s00423-023-02965-7
DOI
10.1007/s00423-023-02965-7
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45275
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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