Outcome of combined complete excision of the caudate lobe with partial hepatectomy for treatment of resectable Klatskin tumors
Bilal O Al-Jiffry1, Mohamed Al Saeed1, Majed Al-Mourgi1, Alaa E Younes1, Samir Badr2, Tamer Abdel-Rahman3, Ayman Attalla4, Abdullah Al-Sawat1, Mohamed Hatem5, Mahmoud El-Meteini6, Ali B Al-Jiffry7
1 Department of Surgery, Taif University, Taif, Saudi Arabia
2 Department of Surgery, Taif University, Taif, Saudi Arabia; Department of Surgery, General Organization of Teaching Hospitals and Institutes, Damanhur, Egypt
3 Department of Surgery, Taif University, Taif, Saudi Arabia; Department of Surgery, General Organization of Teaching Hospitals and Institutes, Benha, Egypt
4 Department of Family Medicine, Taif University, Taif, Saudi Arabia
5 Department of Surgery, Taif University, Taif, Saudi Arabia; Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
6 Department of Hepatobiliary Surgery, Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt
7 Resident in Anesthesia Department, Ta'if, Saudi Arabia
Alaa E Younes
Department of Surgery, Taif University, Taif
Source of Support: None, Conflict of Interest: None
Background and Aim of the Work: Combination of partial hepatectomy with complete excision of the caudate lobe was found to improve the outcome of resectable Klatskin tumors. In this prospective multicenter study, the outcome of these combined resections would be evaluated.
Patients and Methods: This prospective study enrolled 72 patients with resectable Klatskin tumors. The study was conducted in Taif tertiary hospital and Ain Shams University Hospitals from January 2008 to December 2014. All patients underwent partial hepatectomy with complete excision of the caudate lobe after preoperative biliary drainage. The primary outcome was the resection margin (positive or negative), postoperative complications, and patient survival. Other outcomes included; the mean operative time, mean amount of blood loss, and prognostic factors correlated with survival.
Results: The number of patients underwent combined resection were 72 patients, 49 males and 23 females with mean age of 58.3 ± 14.2 years. Mean operative time was 243 ± 57 min and the mean blood loss was 896 ± 211 ml. The recorded postoperative complications included; bile leak in 16.7%, wound infection in 15.3%, pleural effusion in 12.5%, liver failure in 4.2%, and liver abscess in 4.2%. Recorded hospital mortality was 5.6%. The resection margin was negative (R0) in 51/72 patients (70.8%). The overall mean survival during the follow-up was 48 ± 10.2 months. The estimated overall 5-year survival rate was 37.5% increased to 50.1% in R0 patients, and it was 4.8% when the margin was positive. There was a significant positive correlation between the patient survival and the negativity of the resection margin, and a negative significant correlation with the pretreatment level of carcinoembryonic antigen. Age, gender, Bismuth classification, and pretreatment level of carbohydrate antigen 19.9 had insignificant correlation with the survival.
Conclusion: The excision of the caudate lobe with extended hepatic resection by the experienced hepatobiliary surgeon in properly selected patients survival has been proved to be safe and effective.