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Revisiting the Malignant Masquerade at the Liver Hilum: Have We Made Progress?

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Distinguishing malignant from benign causes of obstruction at the liver hilum can pose a diagnostic dilemma. This study aimed to determine factors that predict benign causes of hilar obstruction and long-term outcomes after resection.

Methods

Consecutive patients who underwent surgery for hilar obstruction at a single institution between 1997 and 2022 were retrospectively analyzed. Median follow-up was 26 months (range 0–281 months).

Results

Among 182 patients who underwent surgery for hilar obstruction, 25 (14%) patients were found to have benign disease. Median CA19-9 level after normalization of serum bilirubin was 80 U/mL (range 1–5779) and 21 U/mL (range 1–681) among patients with malignant and benign strictures, respectively (p = 0.001). Cross-sectional imaging features associated with malignancy were lobar atrophy, soft tissue mass/infiltration, and vascular involvement (all p < 0.05). Factors not correlated with malignancy were jaundice upon presentation, peak serum bilirubin, sex, and race. Preoperative bile duct brushing or biopsy had sensitivity and specificity rates of 82% and 55%, respectively. Among patients who underwent resection with curative intent, grade 3–4 complications occurred in 55% and 29% of patients with malignant and benign strictures, respectively (p = 0.028). Postoperative long-term complications of chronic portal hypertension and recurrent cholangitis occurred in ≥ 10% of patients with both benign and malignant disease (p = non-significant).

Conclusions

Strictures at the liver hilum continue to present diagnostic and management challenges. Postoperative complications and long-term sequelae of portal hypertension and recurrent cholangitis develop in a significant number of patients after resection of both benign and malignant strictures.

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Funding

This work was supported by the National Institutes of Health (T32 CA 009599 and P30 CA016672).

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anish J. Jain MD, Mateo Lendoire MD, Artem Boyev DO, Timothy E. Newhook MD, Ching-Wei D. Tzeng MD, Hop S. Tran Cao MD, Jean-Nicolas Vauthey MD & Yun Shin Chun MD

  2. Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Emmanuel Coronel MD & Jeffrey H. Lee MD, MPH

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sunyoung S. Lee MD, PhD, Z. Ian Hu MD, PhD & Milind Javle MD

Authors
  1. Anish J. Jain MD
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  2. Mateo Lendoire MD
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  3. Artem Boyev DO
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  4. Timothy E. Newhook MD
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  7. Emmanuel Coronel MD
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  8. Sunyoung S. Lee MD, PhD
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  9. Z. Ian Hu MD, PhD
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  10. Milind Javle MD
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  11. Jeffrey H. Lee MD, MPH
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  12. Jean-Nicolas Vauthey MD
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  13. Yun Shin Chun MD
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Corresponding author

Correspondence to Yun Shin Chun MD.

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Disclosure

Anish J. Jain, Mateo Lendoire, Artem Boyev, Timothy E. Newhook, Ching-Wei D. Tzeng, Hop S. Tran Cao, Emmanuel Coronel, Sunyoung S. Lee, Z. Ian Hu, Milind Javle, Jeffrey H. Lee, Jean-Nicolas Vauthey, and Yun Shin Chun have no conflicts of interest to declare in relation to this work.

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Jain, A.J., Lendoire, M., Boyev, A. et al. Revisiting the Malignant Masquerade at the Liver Hilum: Have We Made Progress?. Ann Surg Oncol 31, 3062–3068 (2024). https://doi.org/10.1245/s10434-024-14939-0

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  • DOI: https://doi.org/10.1245/s10434-024-14939-0

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