CHOLANGIOCARCINOMA:RESULTS OF SURGICAL TREATMENT

Abstract

Introduction: Surgical treatment of cholangiocarcinomas is accompanied by a great number of postoperative complications and high mortality. This is due to obstructive jaundice and insufficient liver
parenchyma remaining after its extensive resection. The development of irreversible hepatic
decompensation in the post-operative period becomes the main cause of unsatisfactory treatment
outcomes.
Research aim: to improve the outcomes of the surgical treatment of cholangiocarcinomas using
miniinvasive technologies.
Materials and methods: Treatment outcomes for 72 patients with cholangiocarcinomas were
analyzed. All patients underwent radical surgeries. The amount and type of operative treatment
depended on the extent, localization of the tumor, and the Bismuth-Corlette classification.
Results: Percutaneous transhepatic biliary drainage was performed for the decompression of bile
ducts in all patients of Group 1 (n=39, (54.1%)) as pre-operative preparation for the radical surgery.
Embolization of portal vein branches was performed in 4 patients (10.2%) to increase the volume of the
remaining liver parenchyma. Patients from Group 2 (n=33, (45.9%)) were prepared for radical surgeries
through the application of biliodigestive anastomosis, or through the drainage of bile ducts or of the
bladder using laparotomy. Isolated resections of bile ducts were performed in type I and II tumors. Liver
resections up to extended hemihepatectomy were performed in type III and IV tumors. Total caudal
lobectomy and lymph node dissection of the hepatoduodenal ligament was considered mandatory.
Resection of the portal vein was performed in 8 (11.1%) patients. Circular resection was performed in 3
(4.1%) patients, and lateral resection in 5 (6.9%) patients.
Conclusions: Mini-invasive pre-operative preparation reduces the number of complications after
radical surgeries from 39.4% to 17.9%, and the mortality rate from 15.2% to 7.7% as compared to
patients who previously underwent operations using classical methods.