Treatment of gallbladder carcinoma invading porta hepatis with the conventional surgery approach and the transhepatic hilar approach: A retrospective comparative study / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To evaluate the clinical efficacy of transhepatic hilar approach exposing porta hepatis for the treatment of gallbladder carcinoma invading porta hepatis. METHODS: The clinicopathological data of patients with gallbladder carcinoma invading porta hepatis who underwent surgical treatment at Department of General Surgery and Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2007 to December 2017 was collected. There were 39 patients enrolled in the study, including 19 patients in the conventional surgical approach group and 20 patients in the transhepatic hilar approach group. The R0 resection, intraoperative bleeding, postoperative complications and overall survival time were compared between the conventional approach group and the transhepatic hilar approach group. RESULTS: CT and/or MRI were used for preoperative evaluation in the conventional approach group, and CT + MRI + 3 D reconstruction were used in the transhepatic hilar approach group.The accuracy rate of preoperative resectable evaluation was 57.9%(11/19) in the conventional approach group, and 90.0%(18/20) in the transhepatic hilar approach group(P=0.031). The R0 resection rate of the conventional approach group was 26.3%(5/19), while the R0 resection rate of transhepatic hilar approach group was 85.0%(17/20)(P=0.000). The operations of the conventional approach group and the transhepatic hilar approach group were shown as follow S4 b,5 + extrahepatic bile duct (7/8), S4 b,5,6,7,8 + extrahepatic bile duct (3/6), S4 a,4 b,5,6,7,8 +extrahepatic bile duct (0/1), extended resection(1/3) and others (8/2)(P= 0.156). The number of death within 30 days after surgery in the conventional approach group and the transhepatic hilar approach group was 4 and 0 respectively (P=0.047). Among the hepatectomy patients, the blood loss in the conventional approach group was significantly higher than that in the transhepatic hilar approach group [(660 ± 219.1)mL vs.(358.8 ± 184.8)m L,P=0.006]. The postoperative complication rate of Clavien Ⅲ to Clavien Ⅴwas significantly higher in the conventional approach group [Clavien Ⅲ was72.7% vs. 27.8% (P=0.027), Clavien Ⅳ was 45.5% vs. 0 (P=0.004), and Clavien Ⅴ was 27.3% vs. 0(P=0.045)]. The 1-year survival rate of the conventional approach group and the transhepatic hilar approach group was 21.1%(4/19) and61.1%(11/18)(P=0.020), respectively. The overall survival time of the transhepatic hilar approach group was significantly better than that of the conventional approach group(16.0 months vs. 8.4 months, P=0.0005). CONCLUSION: The transhepatic hilar approach can improve the R0 resection rate, reduce intraoperative blood loss, perioperative mortality and serious complication rate, and improve the overall survival time. CT+MRI+3 D reconstruction can improve the accuracy of preoperative resectable evaluation and reduce unnecessary surgical exploration.