Clinical Significance of Left Trisectionectomy for Perihilar Cholangiocarcinoma

Natsume, Seiji; Ebata, Tomoki; Yokoyama, Yukihiro; Igami, Tsuyoshi; Sugawara, Gen; Shimoyama, Yoshie; Nagino, Masato

doi:10.1097/sla.0b013e31824a8d82

Cited by 98 publications

(88 citation statements)

References 39 publications

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“…Surgical resection with curative intent provides the best chance of cure and long‐term survival in patients with resectable extrahepatic cholangiocarcinoma 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Recent advances in dimensional imaging, perioperative management, including biliary drainage and percutaneous transhepatic portal vein embolization, and surgical technique have resulted in increased rates of complete resection with histopathologically negative margins and improved patient survival in patients with extrahepatic cholangiocarcinoma 3, 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances in dimensional imaging, perioperative management, including biliary drainage and percutaneous transhepatic portal vein embolization, and surgical technique have resulted in increased rates of complete resection with histopathologically negative margins and improved patient survival in patients with extrahepatic cholangiocarcinoma 3, 4, 5, 6. However, cancer‐free resection margins at the bile duct stump are difficult to achieve because of longitudinal extension, which is one of the prominent characteristics of extrahepatic cholangiocarcinoma 11, 12.…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Wakai

Sakata

Katada

et al. 2018

Annals of Gastroent Surgery

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Recent advances in dimensional imaging, surgical technique, and perioperative patient care have resulted in increased rates of complete resection with histopathologically negative margins and improved surgical outcomes in patients with extrahepatic cholangiocarcinoma. However, achieving cancer‐free resection margins at ductal stumps in surgery for this disease remains challenging because of longitudinal extension, which is one of the hallmarks of extrahepatic cholangiocarcinoma. When the ductal resection margins are shown to be positive on examination of frozen sections, discrimination between carcinoma in situ and invasive carcinoma is clinically important because residual carcinoma in situ may lead to late local recurrence whereas residual invasive carcinoma is associated with early local recurrence. Residual invasive carcinoma at the ductal margins should be avoided whenever technically feasible. Residual “carcinoma in situ” at the ductal margins appears to be allowed in resection for the advanced disease because it has less effect on survival than other adverse prognostic factors (pN1 and/ or pM1). However, in surgery for early‐stage (pTis‐2N0M0) extrahepatic cholangiocarcinoma, residual carcinoma in situ at the ductal margins may have an adverse effect on long‐term survival, so should be avoided whenever possible. In this review, we focus on the histopathological term “carcinoma in situ,” the biological behavior of residual carcinoma in situ at ductal resection margins, intraoperative histological examination of the ductal resection margins, outcome of additional resection for positive ductal margins, and adjuvant therapy for patients with positive margins.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Wakai

Sakata

Katada

et al. 2018

Annals of Gastroent Surgery

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“…[1][2][3] However, achieving histologically negative margin (R0) resection remains often difficult, although this may offer the only chance for cure and long-term survival. [4][5][6][7][8][9][10][11][12][13] Longitudinally, tumor spreading along the bile duct at the proximal side may be a crucial factor for achieving R0 resection.…”

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confidence: 99%

Surgical Strategy for Hilar Cholangiocarcinoma of the Left-Side Predominance

et al. 2014

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“…Extended hemi-hepatectomy with resection of the caudate lobe and extrahepatic bile duct is often necessary for complete resection [3, 4]. However, these procedures are associated with high rates of mortality and morbidity, even at high-volume centers [5].…”

Section: Introductionmentioning

confidence: 99%

Albumin-Indocyanine Green Evaluation Grading System Predicts Post-Hepatectomy Liver Failure for Biliary Tract Cancer

Miyazaki¹,

Kobayashi

Amikura

et al. 2018

Dig Surg

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Background: In biliary tract cancer treatment, a precise preoperative evaluation of the patient’s liver function is essential to avoid post-hepatectomy liver failure (PHLF) and mortality. The present study aimed to evaluate the role of the Albumin-Indocyanine Green Evaluation (ALICE) grading system in predicting PHLF in biliary tract cancer patients. Methods: Data from 166 patients who underwent hepatectomy for biliary tract cancer between 2000 and 2016 were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the risk factors for PHLF. Results: Among the 166 patients, major hepatectomy was performed in 101 (61%) and bile duct resection was performed in 99 (60%) patients. Thirteen (8%) patients developed PHLF. Furthermore, PHLF, major complications, and mortality were significantly higher in patients with high ALICE grades (≥2b) than in those with low ALICE grades (<2b) (PHLF, 42 vs. 18%, p = 0.002; major complications, 35 vs. 19%, p = 0.036; mortality, 9.3 vs. 0%, p = 0.001). In multivariate analysis, high ALICE grade (p = 0.016) and blood loss ≥1,500 mL (p = 0.009) were identified as independent risk factors for PHLF. Conclusions: The ALICE grading system effectively stratified the risks for PHLF for biliary tract cancer.

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Clinical Significance of Left Trisectionectomy for Perihilar Cholangiocarcinoma

Cited by 98 publications

References 39 publications

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Surgical Strategy for Hilar Cholangiocarcinoma of the Left-Side Predominance

Albumin-Indocyanine Green Evaluation Grading System Predicts Post-Hepatectomy Liver Failure for Biliary Tract Cancer

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