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Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
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Vascular resection for distal cholangiocarcinoma
Ryusei Yamamoto1, Teiichi Sugiura2, Ryo Ashida1
1Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
Surgery Today
|December 22, 2022
Summary
Vascular resection (VR) for distal cholangiocarcinoma (DCC) is linked to worse survival, even with clear margins. VR is often unnecessary when tumor vessels are detachable, suggesting a need to re-evaluate surgical approach for better patient outcomes.
Area of Science:
- Surgical Oncology
- Hepatobiliary Surgery
- Gastrointestinal Oncology
Background:
- Distal cholangiocarcinoma (DCC) treatment often involves aggressive surgical resection.
- Vascular resection (VR) is an extended surgical procedure aiming for negative radial margins (RM) in DCC.
- The role of VR in achieving favorable outcomes for DCC remains debated, particularly concerning its impact on overall survival (OS).
Purpose of the Study:
- To investigate the significance of vascular resection (VR) in distal cholangiocarcinoma (DCC).
- To evaluate the impact of VR and radial margin (RM) status on overall survival (OS) in DCC patients.
- To assess the utility of multidetector-row computed tomography (MDCT) in predicting vascular invasion and guiding surgical decisions.
Main Methods:
- Retrospective review of 230 patients with DCC who underwent surgical resection between 2002 and 2019.
- Analysis of outcomes based on whether vascular resection (VR) was performed.
- Correlation of radial margin (RM) status and findings suggestive of vascular invasion on MDCT with patient survival.
Main Results:
- Patients undergoing VR (25/230) had significantly worse 5-year overall survival (OS) (16.7%) compared to non-VR patients (50.7%).
- Achieving a negative RM via VR did not improve OS compared to non-VR patients with positive RMs (19.7% vs. 35.7%).
- Patients with MDCT-suggestive vascular invasion whose vessels were detachable (11/30) and did not undergo VR had better 5-year OS (57.9%) than those who underwent VR.
Conclusions:
- Vascular resection (VR) for distal cholangiocarcinoma (DCC) is associated with a poor prognosis, irrespective of achieving a negative radial margin (RM).
- VR is often unnecessary for DCC when tumor-involved vessels are found to be detachable from the tumor during surgery.
- Preoperative MDCT assessment for vascular invasion is crucial, and surgical strategy should adapt based on intraoperative findings regarding vessel resectability.
