Indications for extended hepatectomy in the management of stage IV hilar cholangiocarcinoma.

ABSTRACT

HYPOTHESIS: In operations for hilar cholangiocarcinoma, simultaneous extended hepatectomy and removal of extrahepatic bile ducts are considered curative resection. However, the effect of extended operations for stage IV hilar cholangiocarcinoma on survival is still unclear. DESIGN: Retrospective review of the treatment of hilar cholangiocarcinoma from 1981 to 2001. PATIENTS AND METHODS: Fifty-seven patients with stage IVA or IVB hilar cholangiocarcinoma were enrolled. Thirty-three of these patients underwent extended hepatectomy to achieve macroscopic radical resection (surgical group). A self-expandable metallic biliary stent (EMBS) was implanted in 24 patients (EMBS group) in whom radical treatment was judged to be impossible. Main Outcome Measure Survival in patients with stage IV hilar cholangiocarcinoma treated by means of extended operation or stenting. RESULTS: Survival was 25.7 +/- 40.9 months in the surgical group vs 6.5 +/- 5.8 months in the EMBS group (P =.03). In the surgical group, radical resection results were macroscopically and histologically successful in 21 patients (64%). In patients with stage IVB disease, survival did not differ between the surgical and EMBS groups. CONCLUSIONS: In patients with stage IVA disease, radical extended hepatectomy should be performed after excluding patients who have extensive invasion of the hepatic artery or portal vein. However, in patients with stage IVB disease with carcinomatous peritonitis or distant metastasis, there is little possibility of achieving long-term survival with surgery, and stent implantation should be the first choice.