Total laparoscopic radical resection in treatment of hilar cholangiocarcinoma (report of 6 cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DU Yusheng ^1,2 ,  ZHAO Wenxing ² , WANG Ji ² , MA Hongqin ²

1. Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;
2. Department of Tumor Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

ZHAO Wenxing, Email: wxzhao@sina.com

Keywords：

hilar cholangiocarcinoma; laparoscope; minimally invasive surgery

DOI：

10.7507/1007-9424.201706139

Video：

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Objective To explore safety and efficacy of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods From April 2016 and January 2017, 6 patients with hilar cholangiocarcinoma underwent laparoscopic radical resection in the Affiliated Hospital of Xuzhou Medical University were collected. The intra- and post-operative situation and the postoperative complications were analyzed. Results The radical resections of hilar cholangiocarcinoma were completed laparoscopically in all the patients. There was no conversion to the laparotomy. The procedure was finished within a time of (231.3±94.5) min and with an intraoperative blood loss of (123.3±46.8) mL. The first postoperative exhausting time and the postoperative hospital stay was (2.7±0.3) d and (11.9±1.7) d, respectively. All the patients had the R0 resection and the numbers of dissected lymph nodes were 9.4±2.7. The postoperative complications occurred in 2 patients, they were all cured spontaneously in one week, and there was no perioperative death. None of patients had a local recurrence and metastasis during an average 8 months of following-up. Conclusions Preliminary results of limited cases in this study show that with suitable case and skillful laparoscopic technique, laparoscopic radical resection of hilar cholangiocarcinoma is feasible and safe. Further studies are still needed to confirm benefits of this approach.

Citation： DU Yusheng, ZHAO Wenxing, WANG Ji, MA Hongqin. Total laparoscopic radical resection in treatment of hilar cholangiocarcinoma (report of 6 cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(12): 1487-1491. doi: 10.7507/1007-9424.201706139 Copy

1.	张雯雯, 吕少诚, 史宪杰, 等. 单中心 30 年胆道外科疾病谱的变化趋势及意义. 中华医学杂志, 2016, 96(24): 1912-1915.
2.	DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg, 2007, 245(5): 755-762.
3.	Matsuo K, Rocha FG, Ito K, et al. The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg, 2012, 215(3): 343-355.
4.	Molina V, Sampson J, Ferrer J, et al. Surgical treatment of perihilar cholangiocarcinoma: early results of en bloc portal vein resection. Langenbecks Arch Surg, 2017, 402(1): 95-104.
5.	殷晓煜, 刘鑫, 陈伟, 等. 肝门部胆管癌手术切除的远期疗效及预后因素分析. 中华消化外科杂志, 2016, 15(4): 329-334.
6.	Matsuyama R, Mori R, Ota Y, et al. Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol, 2016, 23(Suppl 4): 475-484.
7.	Kang MJ, Jang JY, Chang J, et al. Actual long-term survival outcome of 403 consecutive patients with hilar cholangiocarcinoma. World J Surg, 2016, 40(10): 2451-2459.
8.	张辉, 王孟龙. 单中心 56 例肝门部胆管癌的外科治疗. 中华肝胆外科杂志, 2017, 23(1): 16-19.
9.	Li HZ, Chen JX, Zheng Y, et al. Laparoscopic-assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. J Surg Oncol, 2016, 113(7): 756-767.
10.	王文斌, 闫长青, 吕海涛, 等. 腹腔镜与开腹胰十二指肠切除术疗效分析. 中华肝胆外科杂志, 2017, 23(2): 110-113.
11.	朱安东, 刘奇, 陈德兴. 腹腔镜辅助下肝门部胆管癌根治术 38 例. 中国微创外科杂志, 2012, 12(9): 783-786.
12.	Cho A, Yamamoto H, Kainuma O, et al. Laparoscopy in the management of hilar cholangiocarcinoma. World J Gastroenterol, 2014, 20(41): 15153-15157.
13.	Ikeyama T, Nagino M, Oda K, et al. Surgical approach to Bismuth type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg, 2007, 246(6): 1052-1057.
14.	Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis, 2015, 30(2): 159-171.
15.	Sakamoto Y, Shimada K, Nara S, et al. Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: an analysis of the surgical procedures, surgical margins, and survivals of 77 patients. J Gastrointest Surg, 2010, 14(2): 335-343.
16.	中国医师协会外科医师分会胆道外科医师委员会. 胆道手术加速康复外科专家共识(2016 版). 中华消化外科杂志, 2017, 16(1): 6-13.
17.	Park MJ, Kim YK, Lim S, et al. Hilar cholangiocarcinoma: value of adding DW imaging to gadoxetic acid-enhanced MR imaging with MR cholangiopancreatography for preoperative evaluation. Radiology, 2014, 270(3): 768-776.
18.	Myatra S, Divatia JV, Jibhkate B, et al. Preoperative assessment and optimization in periampullary and pancreatic cancer. Indian J Cancer, 2011, 48(1): 86-93.
19.	Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
20.	陈军, 钱叶本. CT 三维重建在肝门部胆管癌诊疗中的价值. 肝胆外科杂志, 2015, 23(1): 37-40.
21.	陈祖兵, 沈世强. 肝门部胆管癌的围肝门胆管切除术. 国际外科学杂志, 2016, 43(7): 436-438.
22.	胡建昆, 陈志新, 张波, 等. 胃癌根治术中 No.8 淋巴结清扫的意义和技巧. 中国普外基础与临床杂志, 2007, 14(5): 560-563.
23.	张永杰, 俞文隆, 杨珏, 等. 肝门部胆管癌外科治疗的选择与疗效. 中华肝胆外科杂志, 2008, 14(9): 596-600.
24.	Scurtu RR, Dindelegan G, Bintintan V, et al. Extension of hepatic resection ameliorates survival in patients with type Ⅲa or Ⅲb Klatskin tumors despite surgical complications. Chirurgia (Bucur), 2017, 112(3): 301-307.
25.	Chen D, Zhu A, Zhang Z. Total laparoscopic Roux-en-Y cholangiojejunostomy for the treatment of biliary disease. JSLS, 2013, 17(2): 178-187.

1. 张雯雯, 吕少诚, 史宪杰, 等. 单中心 30 年胆道外科疾病谱的变化趋势及意义. 中华医学杂志, 2016, 96(24): 1912-1915.
2. DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg, 2007, 245(5): 755-762.
3. Matsuo K, Rocha FG, Ito K, et al. The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg, 2012, 215(3): 343-355.
4. Molina V, Sampson J, Ferrer J, et al. Surgical treatment of perihilar cholangiocarcinoma: early results of en bloc portal vein resection. Langenbecks Arch Surg, 2017, 402(1): 95-104.
5. 殷晓煜, 刘鑫, 陈伟, 等. 肝门部胆管癌手术切除的远期疗效及预后因素分析. 中华消化外科杂志, 2016, 15(4): 329-334.
6. Matsuyama R, Mori R, Ota Y, et al. Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol, 2016, 23(Suppl 4): 475-484.
7. Kang MJ, Jang JY, Chang J, et al. Actual long-term survival outcome of 403 consecutive patients with hilar cholangiocarcinoma. World J Surg, 2016, 40(10): 2451-2459.
8. 张辉, 王孟龙. 单中心 56 例肝门部胆管癌的外科治疗. 中华肝胆外科杂志, 2017, 23(1): 16-19.
9. Li HZ, Chen JX, Zheng Y, et al. Laparoscopic-assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. J Surg Oncol, 2016, 113(7): 756-767.
10. 王文斌, 闫长青, 吕海涛, 等. 腹腔镜与开腹胰十二指肠切除术疗效分析. 中华肝胆外科杂志, 2017, 23(2): 110-113.
11. 朱安东, 刘奇, 陈德兴. 腹腔镜辅助下肝门部胆管癌根治术 38 例. 中国微创外科杂志, 2012, 12(9): 783-786.
12. Cho A, Yamamoto H, Kainuma O, et al. Laparoscopy in the management of hilar cholangiocarcinoma. World J Gastroenterol, 2014, 20(41): 15153-15157.
13. Ikeyama T, Nagino M, Oda K, et al. Surgical approach to Bismuth type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg, 2007, 246(6): 1052-1057.
14. Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis, 2015, 30(2): 159-171.
15. Sakamoto Y, Shimada K, Nara S, et al. Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: an analysis of the surgical procedures, surgical margins, and survivals of 77 patients. J Gastrointest Surg, 2010, 14(2): 335-343.
16. 中国医师协会外科医师分会胆道外科医师委员会. 胆道手术加速康复外科专家共识(2016 版). 中华消化外科杂志, 2017, 16(1): 6-13.
17. Park MJ, Kim YK, Lim S, et al. Hilar cholangiocarcinoma: value of adding DW imaging to gadoxetic acid-enhanced MR imaging with MR cholangiopancreatography for preoperative evaluation. Radiology, 2014, 270(3): 768-776.
18. Myatra S, Divatia JV, Jibhkate B, et al. Preoperative assessment and optimization in periampullary and pancreatic cancer. Indian J Cancer, 2011, 48(1): 86-93.
19. Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
20. 陈军, 钱叶本. CT 三维重建在肝门部胆管癌诊疗中的价值. 肝胆外科杂志, 2015, 23(1): 37-40.
21. 陈祖兵, 沈世强. 肝门部胆管癌的围肝门胆管切除术. 国际外科学杂志, 2016, 43(7): 436-438.
22. 胡建昆, 陈志新, 张波, 等. 胃癌根治术中 No.8 淋巴结清扫的意义和技巧. 中国普外基础与临床杂志, 2007, 14(5): 560-563.
23. 张永杰, 俞文隆, 杨珏, 等. 肝门部胆管癌外科治疗的选择与疗效. 中华肝胆外科杂志, 2008, 14(9): 596-600.
24. Scurtu RR, Dindelegan G, Bintintan V, et al. Extension of hepatic resection ameliorates survival in patients with type Ⅲa or Ⅲb Klatskin tumors despite surgical complications. Chirurgia (Bucur), 2017, 112(3): 301-307.
25. Chen D, Zhu A, Zhang Z. Total laparoscopic Roux-en-Y cholangiojejunostomy for the treatment of biliary disease. JSLS, 2013, 17(2): 178-187.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Total laparoscopic radical resection in treatment of hilar cholangiocarcinoma (report of 6 cases)

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