Clinical effect of laparoscopic radical resection in treatment of type Ⅳ hilar cholangiocarcinoma

Objective To investigate the feasibility and safety of laparoscopic radical resection in the treatment of type IV hilar cholangio-carcinoma. Methods A retrospective analysis was performed for the clinical data of 4 patients who were admitted to the Affiliated Hospitalof Chuanbei Medical College from July 2015 to September 2018, underwent laparoscopic radical resection, and were diagnosed with type IVhilar cholangiocarcinoma based on postoperative pathology. There were 2 female and 2 male patients aged 53-65 years, with a mean age of59. 4 years. All patients had varying degrees of jaundice before surgery and were given symptomatic treatment including liver-protectingtreatment, jaundice clearance, and nutritional support. Two patients underwent percutaneous transhepatic biliary drainage before surgery toalleviate jaundice. Results All 4 patients underwent a successful laparoscopic surgery, among whom 3 underwent left hemihepatectomy +total caudate lobe resection + lymph node dissection + choledochoenterostomy, and 1 underwent extensive right hemihepatectomy + total cau-date lobe resection + lymph node dissection + choledochoenterostomy. Time of operation was 5. 5-8. 5 hours, and intraoperative blood lossranged from 200 to 750 ml, with 400 ml intraoperative blood transfusion in 1 patient. After surgery, 1 patient had bile leakage and was im-proved and discharged after conservative continuous drainage; 1 patient had massive ascites and was discharged after liver-protecting anddiuretic treatment; no perioperative complication was observed in the other 2 patients. The patients were followed up for 3-24 months aftersurgery; 1 patient developed intrahepatic metastasis at 11 months after surgery and had survived with tumor for 4 months after interventionaltherapy. Conclusion With adequate preoperative assessment, strict control of surgical indications, skilled laparoscopic technique, andstandardized operation, laparoscopic radical resection is feasible and safe in the treatment of type IV hilar cholangiocarcinoma. R0 resectionis an important prognostic factor.