Published online Apr 15, 2022. doi: 10.4251/wjgo.v14.i4.887
Peer-review started: November 3, 2021
First decision: December 2, 2021
Revised: December 16, 2021
Accepted: March 5, 2022
Article in press: March 5, 2022
Published online: April 15, 2022
Processing time: 163 Days and 2 Hours
Hilar cholangiocarcinoma (HC) is a good adaptation certificate of hepatic arterectomy, and hepatic arterectomy is conductive to the radical resection of cholangiocarcinoma, which simplifies the operation and helps with a combined resection of the peripheral portal tissue. With continuous development of surgical techniques, especially microsurgical technique, vascular invasion is no longer a contraindication to surgery in the past 10 years. However, hepatic artery reconstruction after hepatic arterectomy has been performed to treat liver tumor in many centers with better results, but it is rarely applied in advanced HC.
To determine the prognosis of patients with advanced HC after hepatic artery resection and reconstruction.
A total of 98 patients with HC who underwent radical operation in our hospital were selected for this retrospective analysis. According to whether the patients underwent hepatic artery resection and reconstruction or not, they were divided into reconstruction (n = 40) and control (n = 58) groups. The traumatic indices, surgical resection margin, liver function tests before and after the operation, and surgical complications were compared between the two groups.
Operation time, blood loss, hospital stay, and gastrointestinal function recovery time were higher in the reconstruction group than in the control group (P < 0.05); The R0 resection rates were 90.00% and 72.41% in the reconstruction and control groups, respectively (P < 0.05). Serum alanine aminotransferase was lower in the reconstruction group on day one and three postoperatively, whereas serum aspartate aminotransferase was lower on the third day (P < 0.05). Preoperatively, the Karnofsky performance status scores were similar between the groups (P > 0.05), but was higher in the reconstruction group (P < 0.05) two weeks postoperatively. There was no difference in the complication rate between the two groups (27.50% vs 32.67%, P > 0.05). Two-year survival rate (42.50% vs 39.66%) and two-year survival time (22.0 mo vs 23.0 mo) were similar between the groups (P > 0.05).
Radical surgery combined with reconstruction after hepatic artery resection improves R0 resection rate and reduces postoperative liver injury in advanced HC. However, the operation is difficult and the effect on survival time is not clear.
Core Tip: Through retrospective analysis of 98 patients with hilar cholangiocarcinoma, we confirmed that radical surgery combined with reconstruction after hepatic artery resection can increase the R0 resection rate of advanced hilar cholangiocarcinoma and reduce postoperative liver injury. However, this operation is more difficult, and the impact on survival time is still unclear, and further follow-up studies are still needed.