High hilar resection and portojejunal anastomosis: a novel surgical option for Bismuth-Corlette type IIIb hilar cholangiocarcinoma

Objective: To explore the feasibility of applying high hilar resection and portojejunal anastomosis for Bismuth-Corlette type III b hilar cholangiocarcinoma treatment. Methods: From 2004 to 2009, 25 cases of BismuthCorlette type III b hilar cholangiocarcinoma underwent surgical treatment in Shandong University Qilu Hospital. They were divided into 2 groups according to the different operation method received, i.e., high hilar resection and portojejunal anastomosis (PJA) and bile duct plasty and cholangiojejunal anastomosis (CJA). Clinical and follow-up parameters were analyzed retrospectively. Results: Two groups of patients had comparable parameters including age, gender and preoperative assessments. High hilar resection and portojejunal anastomosis (PJA) were performed in 13 patients and bile duct plasty and cholangiojejunal anastomosis (CJA) were conducted in 12 patients. R0 resection rate was similar between the two groups (92.3% vs. 83.3%, P>0.05). However, left hemihepatectomy rate was significantly lower in the PJA group compared to the CJA group (7.7% vs. 83.3%, P=0.001). Operation time and intra-operative blood loss volume were also significantly reduced in the PJA group. Postoperative complications rate and survival rate were comparable between the two groups. Conclusion: High hilar resection and portojejunal anastomosis (PJA) represents onebetter choice for patients with Bismuth-Corlette type III b hilar cholangiocarcinoma, especially for patients with relatively poor health conditions.