Surgical Aspects of Treatment of Hilar Cholangiocarcinoma

Abstract

Introduction. Treatment of hilar cholangiocarcinoma remains one of the most complicated issues of surgical hepatology. As known, hilar cholangiocarcinoma is resistant to chemotherapy and radiation therapy, and only a surgical option is an effective way to improve patient survival.The aim of the study was to improve clinical outcomes of patients with cholangiocarcinoma by evaluating the efficiency of various options for resection and reconstructive and restorative stages of surgical treatment.Methods. The study involved clinical findings and outcomes of 68 patients with hilar cholangiocarcinoma. Biliary decompression was performed in 61 (89.7%) cases. Radical surgical interventions were performed in 35 (51.4%) cases, and palliative surgical interventions were performed in 33 (48.6%) cases.Results. Specific complications at the stage of biliary decompression were noted in 4 (6.5%) cases, inadequate drainage of the biliary tract occurred in 5 (8.2%) cases. The syndrome of "rapid decompression of the biliary tract" was recorded in 14 (23.0%) cases, cholangitis - in 12 (19.7%). Intraoperative complications were noted in 2 (15.3%) cases, postoperative - in 6 (17.1%) cases. Mortality rate was 8.5%. In the long-term period, stenosis of the biliodigistic anastomosis was recorded in 11.4% of cases, tumor recurrence occurred in 28.6% of cases. The five-year survival rate was 17.0%.Conclusion. Resection of the bile ducts combined with hemihepatectomy is an operation accompanied by high risks, especially at the height of jaundice and in the elderly patients. Performing a sparing hiatal resection of the liver and bile ducts provides an acceptable survival rate. The proposed method to form a biliodigistic anastomosis is effective in terms of preventing insolvency and stenosis of the anastomosis.