Betere behandelresultaten bij hilair cholangiocarcinoom na overgang op uitgebreidere ingreep: 20 jaar ervaring AMC.

Thomas M. van Gulik, Jaap J. Kloek, Anthony T. Ruys, Olivier R. C. Busch, Geertjan van Tienhoven, Johan S. Lameris, Erik A. J. Rauws, Dirk J. Gouma

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Abstract

OBJECTIVE: To determine the result of surgical treatment of patients with hilar cholangiocarcinoma (HCCA) before and after the transition from predominantly local bile duct resections to more extensive resections including partial liver resection in order to achieve complete tumour resection in the Academic Medical Center, Amsterdam (The Netherlands). DESIGN: Retrospective and descriptive. METHODS: In the period 1988-2003, 117 consecutive patients underwent resection due to suspected HCCA. Preoperative work-up included staging laparoscopy, preoperative biliary drainage and short-course radiation therapy (3 x 3.5 Gy) to prevent seeding metastases. A more extended multidisciplinary surgical approach combining bile duct resection with partial liver resection was applied as of 1998. Outcomes of resection including 5-year survival were assessed in patients who had undergone resection before (1988-1997; period 1) and after (1998-2003; period 2) this change in surgical approach. RESULTS: In 18 patients (15.3%) a benign lesion was found in the resection specimen. Among the other 99 patients with microscopically confirmed HCCA, 21 (72%) of 29 patients had undergone bile duct resection in combination with partial liver resection in period 2 as compared to 17 (24%) of 70 patients in period 1. The margin tumour free resection rate increased from 20% in period 1 to 59% in period 2. Five-year survival increased from 20% (SE: 5) in period 1, to 33% (SE: 9) in period 2. Morbidity and mortality in period 2 were 69% and 10%, respectively, as compared to 64% and 17% in period 1. CONCLUSION: More extensive resection of HCCA in combination with partial liver resection in the setting of a multidisciplinary approach led to a higher rate of margin free resections and improved 5-year survival.
Original languageDutch
Pages (from-to)1631-1639
JournalNederlands Tijdschrift voor Geneeskunde
Volume154
Issue number35
Publication statusPublished - 2010
Externally publishedYes

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