A Clinicopathological Study of Hilar Cholangiocarcinoma -Surgical Problems in Curative Resection-

Nobuhiko Ueda, Takukazu Nagakawa, Tetsuo Ohta, Tatsuo Nakano, Kazuhiro Mori, Naotaka Kadoya, Hironobu Kobayashi, Yasuharu Nakano, Takashi Nakamura, Masato Kayahara, Keiichi Ueno, Itsuo Miyazaki

Second Department of Surgery, School of Medicine, Kanazawa University

Nineteen resected hilar cholangiocarcinomas were analyzed clinicopathologically to elucidate the surgical problems in curative resection for hilar cholangiocarcinoma. Histological lymph node metastases were within group 2 lymph nodes except for 1 patient. Cancer invasion to the portal vein was histologically positive in 4 of 7 patients with portal vein resection. Two of 3 other patients with negative invasion showed cancer invasion close to the wall of the portal vein. Quadrate lobe invasion was found in 6 of l0 patients (60.0%). Fourteen of 16 patients (87.5%) with histologically positive cancer invasion at the wedge of section were judged to be excisional wedge (ew) positive. Ten patients (55.6%) including 4 patients of portal vein resection were ew positive for large vessels in the hepatoduodenal ligament. Eight patients (44.4%) were ew positive at the hepatic side. Recurrent patterns were accompanied by local recurrence in all patients of primary death. The above results indicate that portal vein resection is thought to be necessary to obtain curative resection for hilar cholangiocarcinoma, but it is necessary to obtain an ew negative state for the hepatic artery from now on. Moreover, the pre and intraoperative closer examination in cancer invasion and quadrate lobe resection is suggested to be necessary to obtain an ew negative state at the hepatic side.

Key words
hilar cholangiocarcinoma, resection of the portal vein, resection of the quadrate lobe of the liver

Reprint requests
Nobuhiko Ueda Second Department of Surgery, School of Medicine, Kanazawa University
13-1 Takara-machi, Kanazawa, 920 JAPAN

Accepted
January 16, 1991

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