Abstract:Objective:To explore the surgical management in patients with Bismuth Ⅳ hilar cholangiocarcinoma.
Methods :Retrospective study was used to analyze the clinical data with operative and pathologic diagnosis of Bismuth Ⅳ hilar cholangiocarcinoma in the recent five years.
Results:Of the 22 patients, there were 13 males and 9 females, with M∶F=1.4∶1. In the group of non liver transplantation (NLTX), 5 cases(31.3%) underwent resection (radical resection in 2 cases; palliative resection in 3 cases), and 11 cases had nonresectional internal or external drainage.In the liver transplantation group(LTX), the resection rate was 100%（6/6）. Five LTX cases survived for 28, 19, 17, 12 and 9 months respectively, and one died from chronic rejection in 11 months after operation. In the NLTX group, the 1and 2yr survival rate was 32.1% and 0% respectively. The 1and 2yr survival rate of LTX was 80.0%（4/5）and 50.0%（1/2）respectively. There was significant difference between the two groups in average survival rate (P=0.041).
Conclusions:Aggressive surgical treatment should be adopted for Bismuth Ⅳ hilar cholangiocarcinoma, and radical resection is crucial to enhance survival rate. LTX is a good choice for the patients with unresectable Bismuth Ⅳ hilar cholangiocarcinoma and the prognosis is satisfactory.