Hilar cholangiocarcinoma: Controversies on the extent of surgical resection aiming at cure

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• 作者：Shuai Xiang (1)
  Wan Yee Lau (2)
  Xiao-ping Chen (1)
  
  1. Hepatic Surgery Centre ; Tongji Hospital ; Tongji Medical College ; Huazhong University of Science and Technology ; Wuhan ; Hubei ; China
  2. Faculty of Medicine ; The Chinese University of Hong Kong ; Shatin ; New Territories ; Hong Kong ; SAR ; China
  
• 关键词：Hilar cholangiocarcinoma ; Negative margin ; Hepatic resection ; Vascular resection
• 刊名：International Journal of Colorectal Disease
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：30
• 期：2
• 页码：159-171
• 全文大小：459 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Internal Medicine
  Gastroenterology
  Hepatology
  Proctology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1262

文摘

Background Hilar cholangiocarcinoma is the most common malignant tumor affecting the extrahepatic bile duct. Surgical treatment offers the only possibility of cure, and it requires removal of all tumoral tissues with adequate resection margins. The aims of this review are to summarize the findings and to discuss the controversies on the extent of surgical resection aiming at cure for hilar cholangiocarcinoma. Methods The English medical literatures on hilar cholangiocarcinoma were studied to review on the relevance of adequate resection margins, routine caudate lobe resection, extent of liver resection, and combined vascular resection on perioperative and long-term survival outcomes of patients with resectable hilar cholangiocarcinoma. Results Complete resection of tumor represents the most important prognostic factor of long-term survival for hilar cholangiocarcinoma. The primary aim of surgery is to achieve R0 resection. When R1 resection is shown intraoperatively, further resection is recommended. Combined hepatic resection is now generally accepted as a standard procedure even for Bismuth type I/II tumors. Routine caudate lobe resection is also advocated for cure. The extent of hepatic resection remains controversial. Most surgeons recommend major hepatic resection. However, minor hepatic resection has also been advocated in most patients. The decision to carry out right- or left-sided hepatectomy is made according to the predominant site of the lesion. Portal vein resection should be considered when its involvement by tumor is suspected. Conclusion The curative treatment of hilar cholangiocarcinoma remains challenging. Advances in hepatobiliary techniques have improved the perioperative and long-term survival outcomes of this tumor.