A simple system to predict perihilar cholangiocarcinoma resectability
Karim Boudjema1, Laurent Sulpice, Sylvain Garnier
1Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France. karim.boudjema@chu-rennes.fr
Summary
A new XY classification system accurately predicts perihilar cholangiocarcinoma (PHC) resectability. Type Y (free left lateral section duct confluence) PHCs are often resectable, while Type X (invaded LLC) require complex vascular reconstruction.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Diagnostic imaging
Background:
- Perihilar cholangiocarcinoma (PHC) poses challenges in determining surgical resectability.
- Predicting resectability is crucial for planning curative treatment strategies.
- The involvement of the left lateral section duct confluence (LLC) is a key factor in PHC resectability.
Purpose of the Study:
- To retrospectively validate a novel XY classification system for predicting PHC resectability.
- To assess the correlation between LLC involvement and vascular invasion in PHC.
- To determine the feasibility of curative resection based on the XY classification.
Main Methods:
- Retrospective review of radiological files for patients operated for PHC.
- Classification of PHC into Type X (invaded LLC) and Type Y (free LLC).
- Matching peroperative findings and follow-up data with the XY classification.
Main Results:
- Of 37 patients, 28 were Type Y and 9 were Type X PHCs.
- Hepatic artery (HA) invasion was 14% in Type Y vs. 100% in Type X (P < 0.001).
- Complete resection rates without HA reconstruction were 89% for Type Y and 33% for Type X (P = 0.01).
Conclusions:
- The XY classification effectively predicts PHC resectability.
- Type Y PHCs are generally resectable without complex vascular reconstruction.
- Type X PHCs often necessitate complex vascular reconstructions for potential resection.
