Portal vein reconstruction during surgery for cholangiocarcinoma

Complete surgical resection is the only curative-intent therapy for patients with hilar cholangiocarcinoma, and obtaining negative pathologic margins is crucial to allow for prolonged disease-free survival. Macrovascular tumor invasion adds technical complexity to surgical extirpation, but can be achieved with en bloc vessel resection. This tumor extension adversely affects overall prognosis, but is nonetheless technically feasible.

Several recent meta-analyses have studied the short and long-term results of concomitant vascular resection during surgery for hilar cholangiocarcinoma. There is little doubt that vascular resection (particularly arterial resection) has been associated with vascular complications and increased mortality. Although R0 rates are lower when vascular abutment is present, achieving an R0 resection consistently is correlated with improved survival. When portal vein resection is necessary, there does not appear to be a difference in disease-free outcome when tumor simply abuts the vein compared to when there is microscopic evidence of pathologic invasion.

When R0 resection of hilar cholangiocarcinoma demands en bloc removal and reconstruction of hilar vessels, perioperative risk may increase, but prognosis is improved. Heterogeneity in published reports still limits our knowledge in this area, and a proposal is made to clarify the extent of vascular reconstruction necessary in these operations for future study.