Oral (pre-recorded)
OB05 Biliary: Technical Outcomes 
Selection of Presentations from Abstract Submissions
OB05-01 Transhepatic Direct Approach to the “Limit of Division of the Hepatic Ducts” Leads to a High R0 Resection Rate in Perihilar Cholangiocarcinoma
Takehiro Noji, Japan

T. Noji, K. Okamura, A. Matsui, K. Tanaka, Y. Nakanishi, T. Asano, T. Nakamura, T. Tsuchikawa, S. Hirano
Gastroenterological Surgery II, Hokakido University Faculty of Medicine, Japan

Objective: To describe a technique of transhepatic direct approach and resection on the limit of division of hepatic ducts, investigate its short-term surgical outcome, and validate whether the radial margin (RM) would have a clinical impact on long-term survival of perihilar cholangiocarcinoma (PHCC) patients.
Summary Background Data: Previous studies have shown that curative resection (R0 resection) was among the most crucial factors for long-term survival of patients with PHCC. To achieve R0 resection, we performed the transhepatic direct approach and resection on the limits of division of the hepatic ducts. Although a recent report showed that the RM status impacted the survival of PHCC patients, it is still unclear whether RM is an important clinical factor.
Methods: Consecutive PHCC patients (n=211) who had undergone major hepatectomy with extrahepatic bile duct resection, without pancreaticoduodenectomy, in our department were retrospectively evaluated.
Result: We excluded 11 patients who died within 90 days. R0 resection rate was 93% and 86% for invasive cancer-free and both invasive cancer and high-grade dysplasia free resection, respectively. Overall 5-year survival rate was 48.5%. Univariate analysis showed that patients with RM-R1 had poor prognosis, but it was not an independent risk factor for survival.
Conclusion: The transhepatic direct approach to the limits of division of the bile ducts leads to a high R0 resection rate in the horizontal margin of PHCC. RM would have a clinical impact on long-term survival of PHCC patients. However, further examination will be needed to determine the adjuvant therapy for PHCC to improve patient survival.