Bismuth-corlette Type Ⅲ And Ⅳ Hilar Cholangiocarcinoma Evaluation Of Resectability And Analysis Of Factors Associated With Postoperative Impact On Survival Time

Objectives:To discuss the key points of preoperative resectability assessment of Bismuth-Corlette type III and IV hilar cholangiocarcinoma and the factors affecting its survival time after surgery,in order to further standardize the treatment of Bismuth-Corlette type III and IV hilar cholangiocarcinoma and improve the prognosis of patients,and to provide a theoretical basis.Methods: The clinicopathological data of 20 patients with Bismuth-Corlette type III and IV hilar cholangiocarcinoma who underwent radical surgery between January2017 and December 2022 were collected from the Department of Hepatobiliary Surgery,Ganmei Hospital,Kunming Medical University.The points of preoperative resectability assessment of Bismuth-Corlette types III and IV hilar cholangiocarcinoma were analyzed by combining the patients’ preoperative cholangiography,CT,MRI/MRCP,3D reconstruction and other imaging examinations and surgical resection.The relevant risk factors that may affect the postoperative survival time of patients were analyzed univariately,and then the above influencing factors were imported into Cox regression analysis to establish Cox risk proportional model to analyze the independent risk factors affecting the postoperative survival time of patients.Different clinical staging situations were compared with the actual surgical resection situation to explore the best staging approach that could guide surgical resection before surgery;Kaplan-Meier survival curves and log-rank tests were used to correlate the relationship between different staging approaches and survival,and to explore the most suitable staging approach for assessing patients’ prognosis.Results: By December 31,2022,the median survival time for the 20 patients was10.70 months,with a mean survival time of 14.79 months.In preoperative resectability assessment,cholangiography underestimates or fails to completely assess the extent of tumor growth within the bile duct,and when combined with CT and MRI/MRCP,it is possible to derive a more accurate assessment.Of the local factors contributing to unresectable tumors,main trunk/contralateral vascular invasion is probably the most critical.In univariate analysis,the presence of underlying disease(P=0.019),lymph node metastasis(P=0.024),CA199 ≥700 U/L(P=0.031),main trunk/bifurcation/contralateral portal vein invasion(P=0.007),and postoperative liver failure(P=0.020)were considered to be significantly correlation(P < 0.05).By COX regression analysis,lymph node metastasis(P=0.010),CA199 ≥700 U/L(P=0.024),and postoperative liver failure(P=0.001)were found to be independent risk factors affecting patients’ survival time.Three-dimensional visualization staging was more comprehensive than Bismuth-Corlette staging,MSKCCT staging,and Gazzaniga T staging in its value for preoperative guidance of surgical resection.mayo staging was superior to TNM staging,MSKCC T staging,and Gazzaniga T staging in assessing patient prognosis.Conclusion(s): Patients with Bismuth-Corlette type III and IV hilar cholangiocarcinoma need to be evaluated preoperatively for adequate resectability in combination with imaging such as cholangiography,CT,MRI/MRCP and 3D reconstruction.Lymph node metastasis,CA199 ≥ 700 U/L,and postoperative liver failure are independent risk factors affecting postoperative survival time.Three-dimensional visual staging is suitable for surgical guidance,and Mayo staging is suitable for prognostic assessment.