Treatment outcomes for patients with Bismuth–Corlette type IV portal cholangiocarcinoma

Aim. To evaluate the treatment outcomes for patients with true type IV portal cholangiocarcinoma according to the Bismuth–Corlette classification.

Materials and methods. The study involved the treatment outcomes of 272 patients with portal cholangiocarcinoma for 2014–2022. Bismuth–Corlette type IV tumors were initially diagnosed in 59 patients.

Results. Upon assessing the anatomy of bile duct confluence using MRI and cholangiography, Bismuth–Corlette type IV tumors were verified in only 22 patients. In other cases, the extent of the tumor process was overestimated due to different anatomical configurations of the duct confluence. Seven patients (33%) underwent surgery, with R0 resection performed in four of them. The median survival after radical surgery accounted for 12 months (8–23 months), while in the palliative group without chemotherapy, it amounted to 3 months (2–12 months), and with chemotherapy – 10 months (3–34 months).

Conclusion. Radical surgical intervention can be performed in one-third of patients with proven Bismuth–Corlette type IV portal cholangiocarcinoma. A comprehensive multidisciplinary approach to treatment enhances the survival duration of palliative patients with portal cholangiocarcinoma.

1. Edge S.B., Compton C.C. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann. Surg. Oncol. 2010; 17 (6): 1471–1474. https://doi.org/10.1245/s10434-010-0985-4

2. Han I.W., Jang J.Y., Kang M.J., Kwon W., Park J.W., Chang Y.R., Kim S.W. Role of resection for Bismuth type IV hilar cholangiocarcinoma and analysis of determining factors for curative resection. Ann. Surg. Treat. Res. 2014; 87 (2): 87–93. https://doi.org/10.4174/astr.2014.87.2.87.

3. Berger M.J., Ettinger D.S., Aston J., Barbour S., Bergsbaken J., Bierman P.J., Brandt D., Dolan D.E., Ellis G., Kim E.J., Kirkegaard S., Kloth D.D., Lagman R., Lim D., Loprinzi C., Ma C.X., Maurer V., Michaud L.B., Nabell L.M., Noonan K., Roeland E., Rugo H.S., Schwartzberg L.S., Scullion B., Timoney J., Todaro B., Urba S.G., Shead D.A., Hughes M. NCCN Guidelines Insights: Antiemesis, Version 2.2017. J. Natl. Compr. Canc. Netw. 2017; 15 (7): 883–893. https://doi.org/10.6004/jnccn.2017.0117.

4. Nakamura T., Tanaka K., Kiuchi T., Kasahara M., Oike F., Ueda M., Kaihara S., Egawa H., Ozden I., Kobayashi N., Uemoto S. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002; 73 (12): 1896–1903. https://doi.org/10.1097/00007890-200206270-00008

5. Shorikov M.A., Sergeeva O.N., Lapteva M.G., Peregudov N.A., Dolgushin B.I. Proximal extrahepatic bile ducts: comprehensive review. Journal of Oncology: Diagnostic Radiology and Radiotherapy. 2021; 4 (1): 74–93. https://doi.org/10.37174/2587-7593-2021-4-1-74-93 (In Russian)

6. Ku D., Tang R., Pang T., Pleass H., Richardson A., Yuen L., Lam V. Survival outcomes of hepatic resections in Bismuth-Corlette type IV cholangiocarcinoma. ANZ J. Surg. 2020; 90 (9): 1604–1614. https://doi.org/10.1111/ans.15531

7. Ebata T., Mizuno T., Yokoyama Y., Igami T., Sugawara G., Nagino M. Surgical resection for Bismuth type IV perihilar cholangiocarcinoma. Br. J. Surg 2018; 105 (7): 829–838. https://doi.org/10.1002/bjs.10556

8. Miyazaki M., Ohtsuka M., Miyakawa S., Nagino M., Yamamoto M., Kokudo N., Sano K., Endo I., Unno M., Chijiiwa K., Horiguchi A., Kinoshita H., Oka M., Kubota K., Sugiyama M., Uemoto S., Shimada M., Suzuki Y., Inui K., Tazuma S., Furuse J., Yanagisawa A., Nakanuma Y., Kijima H., Takada T. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition. J. Hepatobiliary Pancreat. Sci. 2015; 22 (3): 181–196. https://doi.org/10.1002/jhbp.211

9. Li B., Xiong X.Z., Zhou Y., Wu S.J., You Z., Lu J., Cheng N.S. Prognostic value of lymphovascular invasion in Bismuth– Corlette type IV hilar cholangiocarcinoma. World J. Gastroenterol. 2017; 23 (36): 6685–6693. https://doi.org/10.3748/wjg.v23.i36.6685

10. Tan J.W., Hu B.S., Chu Y.J., Tan Y.C., Ji X., Chen K., Ding X.M., Zhang A., Chen F., Dong J.H. One-stage resection for Bismuth type IV hilar cholangiocarcinoma with high hilar resection and parenchyma-preserving strategies: a cohort study. World J. Surg. 2013; 37 (3): 614–621. https://doi.org/10.1007/s00268-012-1878-4

11. Kennedy T.J., Yopp A., Qin Y., Zhao B., Guo P., Liu F., Schwartz L.H., Allen P., D'Angelica M., Fong Y., DeMatteo R.P., Blumgart L.H., Jarnagin W.R. Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB (Oxford). 2009; 11 (5): 445–451. https://doi.org/10.1111/j.1477-2574.2009.00090.x

12. Enomoto L.M., Dixon M.E.B., Burdette A., Gusani N.J. Biliary drainage before and after liver resection for perihilar cholangiocarcinoma. Am. Surg. 2020; 86 (6): 628–634. https://doi.org/10.1177/0003134820923287

13. O'Brien S., Bhutiani N., Egger M.E., Brown A.N., Weaver K.H., Kline D., Kelly L.R., Scoggins C.R., Martin R.C.G. 2nd, Vitale G.C. Comparing the efficacy of initial percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stenting for relief of biliary obstruction in unresectable cholangiocarcinoma. Surg. Endosc. 2020; 34 (3): 1186–1190. https://doi.org/10.1007/s00464-019-06871-2

14. Enomoto L.M., Dixon M.E.B., Burdette A., Gusani N.J. Biliary drainage before and after liver resection for perihilar cholangiocarcinoma. Am. Surg. 2020; 86 (6): 628–634. https://doi.org/10.1177/0003134820923287

15. Wiggers J.K., Coelen R.J., Rauws E.A., van Delden O.M., van Eijck C.H., de Jonge J., Porte R.J., Buis C.I., Dejong C.H., Molenaar I.Q., Besselink M.G., Busch O.R., Dijkgraaf M.G., van Gulik T.M. Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial): design and rationale of a randomized controlled trial. BMC Gastroenterol. 2015; 15: 20. https://doi.org/10.1186/s12876-015-0251-0

16. Luo L., Yao Y., Liao H., Huang J., Liao M., Wang J., Yuan K., Zeng Y. Cumulative damage effect of jaundice may be an effective predictor of complications in patients undergoing radical resection of Bismuth type II or above hilar cholangiocarcinoma. Ann. Transl. Med. 2021; 9 (10): 861. https://doi.org/10.21037/atm-21-1860

17. Páez-Carpio A., Hessheimer A., Bermúdez P., Zarco F.X., Serrano E., Moreno J., Molina V., Ausania F., Carrero E., Burrel M., Fondevila C., Gómez F.M. Percutaneous transhepatic biliary drainage for biliary obstruction in perihilar cholangiocarcinoma: a 10-year analysis of safety and outcomes using the CCI index. Langenbecks Arch. Surg. 2023; 408 (1): 109. https://doi.org/10.1007/s00423-023-02852-1