Treatment Of Hilar Cholangiocarcinoma Research Articles

Surgical treatment for hilar cholangiocarcinoma of Bismuth-Corlette type IV

To investigate the surgical treatment for hilar cholangiocarcinoma(HCCA) of Bismuth-Corlette type IV. The clinical data of 73 HCCA patients admitted in Southwest Hospital, the Third Military Medical University from January 2002 to December 2008 were analyzed retrospectively. There were 41 males and 32 females, aged from 30 to 84 years old (averaged, 56.8 years old). All patients were diagnosed as hilar mass with hilar biliary obstruction by B-ultrasound, CT, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography or percutaneous transhepatic cholangiography, and confirmed by pathological examination in intra-operation and post-operation. Diagnosis of all patients were according to Bismuth-Corlette type IV. Fifteen cases underwent percutaneous transhepatic cholangial drainage, stents were implanted in 8 patients. Simple internal drainage was performed on 25 of the 73 patients and 4 with palliative resection. Radical resection was performed on 19 patients. The radical resection rate of HCCA were 26.0%. The 1, 3 years of survival rates were 36.8%, 10.5% respectively. The 1 year survival rate was 6.3% in drainage group. Radical resection is the potentially curative treatment for HCCA, a sufficient, reasonable use of internal and external drainage would improve the patient's quality of life.

To further improve the effects of surgical treatment for hilar cholangiocarcinoma

随着现代影像和手术技术的提高以及围手术期处理的进步,肝门部胆管癌的外科治疗效果已有显著提高.近几年,日本及欧美国家报告肝门部胆管癌患者术后5年生存率已提高到30%左右;在我国,黄志强教授报告解放军总医院1993年至2004年行肝门部胆管癌切除术198例,术后1、3、5年累计生存率分别为95.38%、48.97%和26.30%,这一结果与国外报道相似.尽管如此,肝门部胆管癌外科治疗效果在总体上还不能令人满意,需要在如下几个方面加强临床多中心联合,开展前瞻性随机对照研究,以期进一步提高外科治疗的效果。

Treatment of hilar cholangiocarcinoma by liver transplantation

肝门部胆管癌治疗困难,预后较差,是目前胆道外科面临的一个难题.手术切除是治疗肝门部胆管癌的主要方法,但远期效果令人沮丧.肝移植为肝门部胆管癌的根治带来了新的希望.该文总结近年来这一领域的新进展。

Efficacy of celecoxib in the treatment of hilar cholangiocarcinoma: an analysis of 24 cases

Efficacy of celecoxib in the treatment of hilar cholangiocarcinoma: an analysis of 24 cases

Clinical analysis of curative resection with hemihepatectomy for advanced hilar cholangiocarcinoma

To investigate the superiority of curative resection with hemihepatectomy in treatment of hilar cholangiocarcinoma and the strategy to lower the incidence of complications and mortality. The clinical data of 50 patients with hilar cholangiocarcinoma who underwent surgical procedures in Peking University School of Oncology from January 1998 to May 2006 were retrospectively analyzed. Forty-one patients (56.9%) underwent surgical resection. Twenty-two (53.6%) received a radical operation (RO). Thirty patients underwent preoperative percutaneous transhepatic cholangio-drainage (PTCD) to reduce the jaundice. Curative resection with hemihepatectomy was performed on 19 cases including 14 cases undergoing RO. Two patients who had undergone hemihepatectomy died of liver failure. The postoperative morbidity rate was 62% in all 50 cases, 78% in the hemihepatectomy group. The 1- and 2-year survival rates of the hemihepatectomy group were 57.1% and 27.3% respectively. Curative resection with hemihepatectomy is a safe and effective option for hilar cholangiocarcinoma, especially for Bismuth III or IV type. Preoperative biliary drainage is necessary before a major hepatic resection.

Surgery for hilar cholangiocarcinoma: The Leeds experience

Aim To review the experience with hilar cholangiocarcinoma and to determine the results of a radical surgical approach in a UK centre. Methods A 10-year review of all patients treated surgically for proximal bile duct carcinoma at a single surgical unit was conducted. Patient demographics, disease details and histopathology reports were reviewed. From January 1993 through December 2003, 106 patients were admitted with the diagnosis of hilar cholangiocarcinoma and 61 patients received surgical exploration. Results Tumours were staged as follows (UICC 6th edition): stage IB, n = 10 IIA, n = 9; IIB, n = 20; III, n = 8; IV, n = 14. Out of 61 patients, 44 had a resection (3 bile duct resection alone, 41 liver resection with bile duct resection), 5 were considered unresectable and 12 underwent liver transplantation (LT). The caudate lobe was excised in 34 of the patients and regional lymphadenectomy was systematically carried out. Para-aortic lymphadenectomy was performed in 17 cases. Portal vein resection was needed in 17 and hepatic artery resection was performed in 4 cases. Negative histologic margins (R0) were achieved in 20 patients and microscopic margin involvement (R1) was seen in 16. In the remaining 8 resected patients, localised metastasis were found (peritoneal deposits in 2, liver metastasis in 4 and positive para-aortic lymph nodes in 2); nevertheless the resection was performed and it was considered R2. Overall survival at 3 and 5 years for patients who underwent a resection was 43% and 28% including postoperative deaths. The 1-, 3- and 5-year actuarial survival rates for patients who underwent R0 resection were 78%, 64% and 45% respectively, including the postoperative deaths ( n = 3). The median survival time was 41.1 months. The 1-, 3- and 5-year actuarial survival rates for R1 resection and R2 were 60%, 26%, 26% and 25% and 0% respectively, while the median survival time for these groups was 15.4 and 6.8 months respectively. The actuarial survival rate at 1, 3 and 5 years for well-differentiated tumours (G1) was 73%, 54% and 40% (median 39.7 months). The figures for G2 were 60%, 48% and 0%. The figures for G3 (poorly differentiated) were 16% and 0% at three years ( p = 0.03).The overall survival at 3 and 5 years for those patients who had a liver transplant was 41% and 20% including early postoperative mortality. The tumour grading (presence of poorly differentiated tumour) was found to be the only independent factor affecting the survival time producing a hazard ratio of 4.3 ( p = 0.0034, 95% confidence interval 0.1007–6.342). Conclusions Radical surgical resection is the best treatment for hilar cholangiocarcinoma. R0 resection provides acceptable 5-year survival, but R1 resection may also provide acceptable palliation. In our experience TNM stage and tumour grade were the main determinants of long-term survival.

Analysis of the placement of multiple metallic stents in the treatment of hilar cholangiocarcinoma

目的 探讨应用金属内支架治疗复杂型肝门部胆管癌,特别是侵犯肝内胆管的肝门部胆管癌的介入治疗方法 .方法 肝门部胆管癌45例,其中BismuthⅡ型12例、Ⅲa型17例、Ⅲb型10例、Ⅳ型6例.45例均先行经皮经肝胆管引流术后实施胆管内支架置入术,分别以T、Y、X型或其组合方式留置2或3枚内支架.结果 45例患者内支架96枚全部置入成功,治疗后胆红素[(312±249)μmol/L]与治疗前[(51±42)μmol/L]相比明显下降(t=4.21,P＜0.01),支架置入后30 d内病死率为2.2%(1/45).平均支架开通时间181.5 d(26～473 d),平均生存时间215.3 d(26～516 d).结论 对于复杂型肝门部胆管癌,胆管内支架治疗是一种有效改善患者生存质量的方法 .特别对病变侵犯肝内胆管的病例,应选择不同的穿刺路径及支架留置方法 ,尽可能解决更多肝段的胆管引流。

Recent advance in the treatment of hilar cholangiocarcinoma: hepatectomy with vascular resection

Radical surgical resection has been revealed to be the only hope of cure for the patient with hilar cholangiocarcinoma. Therefore, major efforts have been made to increase the resection rate by surgeons employing combined hepatic resection and vascular resection of the portal vein and the hepatic artery. Especially, the technical feasibility and surgical safety of hepatic resection with combined portal vein resection have recently been reported by several authors. On the other hand, there have been few reports of combined hepatic artery resection in hilar cholangiocarcinoma. There are fears that combined vascular resection with extended hepatectomy for hilar cholangiocarcinoma may lead to high surgical morbidity and mortality. Herein, we describe the results of aggressive surgical approaches in our series, and we also review the outcomes of hepatic resection with combined vascular resection in the previously reported literature.

Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization

The clinical application of portal vein embolization (PVE) has contributed to improving the postoperative outcome of hilar cholangiocarcinoma. The enlarged nonembolized lobe after PVE protects the patient from postoperative hepatic failure, due to the increased functional reserve, and shortens the hospital stay. Although numerous reports have shown beneficial effects of PVE on postoperative outcome after extended hepatectomy, no randomized controlled study has been performed so far. It is urgent to establish a "gold standard" of PVE, because the indications, approach to the portal vein, types of embolic materials, and methods used to evaluate the function of the future liver remnant are variable among institutions. The indications and procedures of PVE for hilar cholangiocarcinoma may be different from those for hepatocellular carcinoma or colorectal metastasis, because, in many patients with hilar cholangiocarcinoma, biliary cancer is associated with biliary obstruction and cholangitis. This review article summarizes the contribution of PVE to the outcome of postoperative management in patients with hilar cholangiocarcinoma needing extended hepatectomy. We also describe our PVE procedure, which has been established from our experience of more than 240 cases of biliary cancer. Furthermore, the drawbacks of PVE, which may reduce the pool of candidates for surgery, are also discussed.

Advancement in researches of diagnosis and treatment of hilar cholangiocarcinoma

Advancement in researches of diagnosis and treatment of hilar cholangiocarcinoma

Treatment of hilar cholangiocarcinoma with liver transplantation

一、肝门部胆管癌的治疗现状 肝门部胆管癌(hilar cholangiocarcinomas)又称高位(high cholangiocarcinoma,HCCA)或近端胆管癌,是指发生在胆囊管开口以上肝管的上1/3肝外胆管,并常累及胆管汇合部和单侧或双侧肝管的恶性肿瘤。

Hepatectomy with portal vein resection and reconstruction in the treatment of hilar cholangiocarcinoma

To summarize the clinical experience and the role of hepatectomy with portal vein resection and reconstruction hilar cholangiocarcinoma. From 1998 to 2003, the clinical records of 118 cases with hilar cholangiocarcinoma were reviewed. Of the 118 patients, 66 were performed palliative treatment; and 52 patients underwent radical resection, of which 47 patients, including 11 cases combined with portal vein resection and reconstruction, underwent hepatectomy. The rate of postoperation complication was 22.9% and 27.3% in hepatectomy with or without portal vein resection and reconstruction respectively. The 1, 3-year survival rate were 85.7%, 31.4% and 81.8%, 27.8% in hepatectomy with or without portal vein resection and reconstruction respectively (P > 0.05). Only 5 patients were alive more than 3 years (7.58%), and no patient with palliative treatment lived over 5 years. Portal vain invasion is not the contraindication of resection for hilar cholangiocarcinoma. Hepatectomy with portal vein resection and reconstruction may raise the radical resection rate of hilar cholangiocarcinoma and improve the results of prognosis.

Changing Perspectives in the Assessment of Resectability of Hilar Cholangiocarcinoma

Changing Perspectives in the Assessment of Resectability of Hilar Cholangiocarcinoma

Improved Outcome of Resection of Hilar Cholangiocarcinoma (Klatskin Tumor)

Treatment of hilar cholangiocarcinoma (Klatskin tumors) has changed in many aspects. A more extensive surgical approach, as proposed by Japanese surgeons, has been applied in our center over the last 5 years; it combines hilar resection with partial hepatectomy for most tumors. The aim of this study was to assess the outcome of a 15-year evolution in the surgical treatment of Klatskin tumors. A total of 99 consecutive patients underwent resection for hilar cholangiocarcinoma in three 5-year time periods: periods 1 (1988-1993; n=45), 2 (1993-1998; n=25), and 3 (1998-2003; n=29). Outcome was evaluated by assessment of completeness of resection, postoperative morbidity and mortality, and survival. The proportion of margin negative resections increased significantly from 13% in period 1 to 59% in period 3 (P<.05). Two-year survival increased significantly from 33%+/-7% and 39%+/-10% in periods 1 and 2 to 60%+/-11% in period 3 (P<.05). Postoperative morbidity and mortality were considerable but did not increase with this changed surgical strategy (68% and 10%, respectively, in period 3). Lymph node metastasis was, next to period of resection, also associated with survival in univariate analysis. Mainly in the last 5-year period (1998-2003), when the Japanese surgical approach was followed, more hilar resections were combined with partial liver resections that included segments 1 and 4, thus leading to more R0 resections. This, together with a decrease in lymph node metastases, resulted in improved survival without significantly affecting postoperative morbidity or mortality.

EKSTRAHEPATIC BILE DUCT CANCER

Background. Malignant strictures involving the bile ducts remain a major challenge in biliary surgery. It is an uncommon cancer. The etiology is unknown, most cases are sporadic, but several conditions confer an incrised risk of developing cholangiocarcinoma. Clinical presentation and preoperative evaluation. The early simptoms are nonspecific. In the past computed tomography, percutaneous transhepatic cholangiography and angiography were considered standard investigations, but currently magnetic resonance cholangiopancreatography is providing the same information with less risk. Evaluation of patients is principally an assessment of resectability since resection is the only effective therapy. BismuthCorlette classification and determinants of resectability are presented. Treatment. Different kinds of resections are used, according to the type of tumor based on Bismuth-Corlette classification. If resection is not possible, intrahepatic biliary-enteric bypass or percutaneous biliary drainage are performed. Currently there is no role for adjuvant radiochemotherapy. Conclusions. The treatment of hilar cholangiocarcinoma continues to evolve. Jucidious use of preoperative investigations and improvements in surgical tehnique has allowed better patient selection and performance of appropriately radical operations with an acceptable mortality.

Partial hepatectomy with skeletonization of the hepatoduodenal ligament for hilar cholangiocarcinoma

To sum up author's experience and to define the role of partial hepatectomy with skeletonization resection in the treatment of hilar cholangiocarcinoma. Between January 1999 and December 2001, 67 patients underwent exploration in our hospital. The clinical records of these patients were reviewed. Sixty-five (97%) patients underwent surgical resection. Forty-nine patients (73%) had curative resection [22 skeletonization resection (SR), and the other 27 undergone SR combined with partial hepatectomy]. According to the Bismuth-Corlett classification, tumors were classified into four types. SR was performed in type I (5 cases) and type II (17 cases). Right lobectomy with right caudate lobectomy was performed in type IIIa (6 cases), left lobectomy with left caudate lobectomy in type IIIb (15 cases). Right lobectomy with whole caudate lobectomy (3 cases), left lobectomy with whole caudate lobectomy (9 cases), and quadrate lobectomy (2 cases) were undertaken in type IV. We successfully did SR and left lobectomy with whole caudate lobectomy in 2 patients (3%) who had suffered palliative biliary cancer resection and cholangiojejunostomy before. Eight patients (12%) had local resection of the tumor with Roux-en-Y hepaticojejunostomy reconstruction and intrahepatic bile ducts support. Two patients (3%) had palliative biliary drainage. Combined portal vein resection was performed in 13 (20%) patients and hepatic artery resection in 27 (40.3%). Twenty-four (35.8%) patients had no postoperative complications, and 20 (30.2%) patients developed major complications. Of the 20 patients with major complications 14 recovered; the remaining 6 patients died of liver-renal failure with other organ failure or of heart attack, intraabdominal bleeding, and gastrointestinal bleeding in 7, 12, 14, 42, 57, or 89 days after surgery. Thirty days operative mortality was 4.5%. The median survival of patients with curative resection was 16 months (ranging from 1 to 41 months), while the median survival with palliative operation was 7 months (ranging from 1 to 16 months). Partial hepatectomy with skeletonization resection for hilar cholangiocarcinoma can be performed with acceptable morbidity and mortality. For curative treatment of hilar cholangiocarcinoma, Caudate lobectomy is always recommended in Bismuth type III/IV.

Increased bacterobilia associated with preoperative biliary drainage in patients with hilar cholangiocarcinoma

Background Internal biliary drainage is known to reverse many of the pathophysiological disturbances seen in jaundiced patients. However, previous studies examining the effectiveness of preoperative biliary drainage in reducing morbidity and mortality rates in patients undergoing surgical intervention have been disappointing. The aim of this study was to evaluate the effect of preoperative biliary stenting on the incidence of bacterobilia and postoperative complications following surgical treatment of hilar cholangiocarcinoma. Methods Between 1988 and 1998, 127 patients with hilar cholangiocarcinoma were managed in a tertiary referral unit. Forty seven of these patients (37%) underwent curative resection or palliative biliary bypass procedures. Postoperative morbidity and mortality rates were compared in patients who had preoperative biliary drainage (PBD) (n = 20) and those who had no preoperative biliary drainage (NPBD) (n = 27). Results The median bilirubin concentration fell significantly in the PBD group after stent insertion and was significantly lower than in the NPBD group at the time of surgical intervention (110 mmol/L in PBD group versus 335 mmol/L in NPBD group; p Discussion Preoperative biliary drainage for hilar cholangiocarcinoma significantly increases the incidence of contaminated bile. A satisfactory period of preoperative biliary drainage does not reduce the incidence of postoperative complications in patients undergoing surgical intervention and is associated with increased hospital stay.

What constitutes long term survival after surgery for hilar cholangiocarcinoma?

BACKGROUND Hilar cholangiocarcinomas are rarely considered to be resectable and specific data regarding long term survival are not available. METHODS A retrospective single center experience from 1971 and 1995 details long term survival among 339 patients who underwent surgery for adenocarcinoma of the hepatic duct bifurcation. Tumor removal was accomplished by resection of the bile duct bifurcation either alone (33 patients), in combination with hepatic resection (77 patients), or combined with hepatic and vascular resection (41 patients). Thirty-two patients underwent total hepatectomy and liver transplantation. In 188 patients the tumor was unresectable and palliative internal or external biliary drainage was established. The resectability rate was 49.2% and rose to 54% after inclusion of liver transplantation. The clinicopathologic features of 32 5-year survivors were compared with patients whose survival was less than 5 years. RESULTS Thirty-two patients survived longer than 5 years after surgical treatment of hilar cholangiocarcinoma; 22 of these patients (69%) were still alive at last follow-up. Twenty-six long term survivors had primarily undergone resection; 4 received liver transplants. There was 1 long term survivor beyond 5 years after both exploratory laparotomy and subsequent percutaneous transhepatic drainage, and palliative hepatojejunostomy. Long term survival after resection was significantly associated with less advanced tumor stages. Lymph node involvement and residual tumor were the primary prognostic factors both in a multivariate analysis after resection and in the cohort of long term survivors. Nevertheless, long term survivors were still at a significant risk to die from tumor recurrence. CONCLUSIONS Radical resection offers the best possibility of prolonged survival with a good quality of life for patients with hilar cholangiocarcinoma. Cancer 1997; 79:26-34. © 1997 American Cancer Society.

Internal biliary drainage and local radiotherapy with iridium-192 wire in treatment of hilar cholangiocarcinoma

Curative surgery is not possible in the vast majority of patients who present with hilar cholangiocarcinoma. Palliative therapy to relieve jaundice, either at laparotomy or percutaneously, is therefore necessary. The mean survival of these patients is of the order of 8.5 months (Wheeler et al., 1981). We report a significant increase in mean survival to 16.8 months in patients treated with internal biliary drainage when combined with local irradiation to the tumour with iridium-192.