Detailed Abstract
[E-poster - Liver (Liver Disease/Surgery)]
[EP 073] Outcomes of Hilar Cholangiocarcinoma: Experience from Tertiary Referral Hepatopancreatobiliary Surgical Unit in Sri Lanka
Duminda SUBASINGHE 1, Jesudhasan MITHUSHAN 1, Nilesh FERNANDOPULLE 1, Vihara DASSANAYAKE 2, Sivasuriya SIVAGANESH 1
1 Division of HPB Surgery,Department of Surgery, University of Colombo, SRI LANKA, 2 Department of Anaesthesiology And Critical Care, University of Colombo, SRI LANKA
Background : Hilar cholangiocarcinoma(HC) is the most prevalent type of bile duct malignancy. Surgery is the most effective treatment.
Methods : A retrospective analysis of prospective database of HC from 2019 to 2023 in a single HPB surgical unit.
Results : There were 27 patients. Mean age was 61 years (range 30-82 years) with a male: female ratio of 2:1. Mean duration of symptoms was 2.8 months. Jaundice (n=21,78%) was the commonest symptom, followed by anorexia and weight loss (n=18,67%), abdominal pain (n=5, 19%), cholangitis (n=4, 15%). Most tumours were Bismuth type 2 and 4 (each n=9). Staging laparoscopy was positive for peritoneal metastases in (6/9, 67%). Overall, metastatic tumours were present in 48% (n=13). There were 9(33%) locally advanced tumours which were unresectable based on cross sectional imaging. Only 5(18%) had curative intent surgical resections. Two underwent preoperative right portal vein embolization. Surgical procedures included extended right hepatectomy (ERH)+ resection of extra hepatic biliary tree with Roux-en-Y hepatico-jejunostomy (n =3, 11%), left hemihepatectomy with Roux-en-Y hepatico-jejunostomy (n=2, 7%). Portal vein resection and reconstruction was performed in three. Palliative procedures include ERCP+biliary stenting(n=13, 48%), external biliary drainage+internalization (n=8, 29%), and EUS-BD (n=1,3%). There was one post-operative mortality due to post-hepatectomy liver dysfunction. Post-operative complications included pneumonia (n=3) and transient liver dysfunction (n=2).Two patients had R1 resection, and one patient developed malignant bilio-cutaneous fistula.
Conclusions : The outlook for HC remains unfavorable in our center due to metastatic disease and unresectable stage at presentation. Early detection, referral, and timely surgical resections can improve outcomes for affected patients.
Methods : A retrospective analysis of prospective database of HC from 2019 to 2023 in a single HPB surgical unit.
Results : There were 27 patients. Mean age was 61 years (range 30-82 years) with a male: female ratio of 2:1. Mean duration of symptoms was 2.8 months. Jaundice (n=21,78%) was the commonest symptom, followed by anorexia and weight loss (n=18,67%), abdominal pain (n=5, 19%), cholangitis (n=4, 15%). Most tumours were Bismuth type 2 and 4 (each n=9). Staging laparoscopy was positive for peritoneal metastases in (6/9, 67%). Overall, metastatic tumours were present in 48% (n=13). There were 9(33%) locally advanced tumours which were unresectable based on cross sectional imaging. Only 5(18%) had curative intent surgical resections. Two underwent preoperative right portal vein embolization. Surgical procedures included extended right hepatectomy (ERH)+ resection of extra hepatic biliary tree with Roux-en-Y hepatico-jejunostomy (n =3, 11%), left hemihepatectomy with Roux-en-Y hepatico-jejunostomy (n=2, 7%). Portal vein resection and reconstruction was performed in three. Palliative procedures include ERCP+biliary stenting(n=13, 48%), external biliary drainage+internalization (n=8, 29%), and EUS-BD (n=1,3%). There was one post-operative mortality due to post-hepatectomy liver dysfunction. Post-operative complications included pneumonia (n=3) and transient liver dysfunction (n=2).Two patients had R1 resection, and one patient developed malignant bilio-cutaneous fistula.
Conclusions : The outlook for HC remains unfavorable in our center due to metastatic disease and unresectable stage at presentation. Early detection, referral, and timely surgical resections can improve outcomes for affected patients.
SESSION
E-poster
E-Session 03/21 ALL DAY