Curative Resection for Hilar Cholangiocarcinoma: Single-Center Experience with Long-Term Follow-Up

Feo, Claudio F; Ginesu, Giorgio Carlo; Barmina, Michele; Pinna, Antonio; Scanu, Antonio Mario; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto

doi:10.1177/000313481808400106

Cited by 4 publications

(4 citation statements)

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“…At the time of this review, a total of 13 studies were found in which HPD was used for treatment of either GC or ECC. HPD represents the only curative treatment for GC and ECC (the latter also known as ‘Klatskin tumour’, or ‘hilar cholangiocarcinoma’ or ‘peri-hilar cholangiocarcinoma’), having extensive horizontal tumor spread with infiltration of the hepatic hilum and the intrapancreatic bile duct, due to the tissue invasion via the lymphatics and perineural spaces[ 3 , 4 ]. While CG and ECC represent the main indication for HPD, in a minority of cases this surgical approach has been used also in patients having benign disease, liver cancer, neuroendocrine tumours (especially pancreatic neuroendocrine tumor metastatic to the liver) and other malignancies[ 8 , 9 , 12 - 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…Gallbladder cancer (GC) and extrahepatic cholangiocarcinoma (ECC) are tumours with dismal prognosis. Resection provides the only chance of cure, although this kind of surgery is technically challenging due to the complexity of biliary and vascular anatomy of the hepatobiliary-pancreatic region, and the necessity to perform extended hepatic resection[ 1 - 4 ]. In general, biliary cancers have various modes of local extension, including a ‘horizontal spread’ involving the entire extrahepatic biliary tree.…”

Section: Introductionmentioning

confidence: 99%

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Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review

Fancellu

Sanna

Deiana

et al. 2021

WJGO

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BACKGROUND Hepatopancreatoduodenectomy (HPD) is the simultaneous combination of hepatic resection, pancreaticoduodenectomy, and resection of the entire extrahepatic biliary system. HPD is not a universally accepted due to high mortality and morbidity rates, as well as to controversial survival benefits. AIM To evaluate the current role of HPD for curative treatment of gallbladder cancer (GC) or extrahepatic cholangiocarcinoma (ECC) invading both the hepatic hilum and the intrapancreatic common bile duct. METHODS A systematic literature search using the PubMed, Web of Science, and Scopus databases was performed to identify studies reporting on HPD, using the following keywords: ‘Hepatopancreaticoduodenectomy’, ‘hepatopancreatoduodenectomy’, ‘hepatopancreatectomy’, ‘pancreaticoduodenectomy’, ‘hepatectomy’, ‘hepatic resection’, ‘liver resection’, ‘Whipple procedure’, ‘bile duct cancer’, ‘gallbladder cancer’, and ‘cholangiocarcinoma’. RESULTS This updated systematic review, focusing on 13 papers published between 2015 and 2020, found that rates of morbidity for HPD have remained high, ranging between 37.0% and 97.4%, while liver failure and pancreatic fistula are the most serious complications. However, perioperative mortality for HPD has decreased compared to initial experiences, and varies between 0% and 26%, although in selected center it is well below 10%. Long term survival outcomes can be achieved in selected patients with R0 resection, although 5–year survival is better for ECC than GC. CONCLUSION The present review supports the role of HPD in patients with GC and ECC with horizontal spread involving the hepatic hilum and the intrapancreatic bile duct, provided that it is performed in centers with high experience in hepatobiliary-pancreatic surgery. Extensive use of preoperative portal vein embolization, and preoperative biliary drainage in patients with obstructive jaundice, represent strategies for decreasing the occurrence and severity of postoperative complications. It is advisable to develop internationally-accepted protocols for patient selection, preoperative assessment, operative technique, and perioperative care, in order to better define which patients would benefit from HPD.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review

Fancellu

Sanna

Deiana

et al. 2021

WJGO

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“…At the moment, the use of preoperative biliary drainage and portal vein embolization in curative-intent surgery for PHC is higher in East Asian surgical centres (27)(28)(29)(30)(31)(32)(33)(82)(83)(84)(85), compared to the Western centres (34,35,40,43,52,79,(86)(87)(88)(89)(90).…”

Section: Discussion Discussionmentioning

confidence: 99%

“…90) (table 2). In the present series major hepatectomies were used in 80.7% of patients, and portal vein resection and reconstruction was performed in 16.7% of patients.The use of preoperative biliary drainage in recent series of Western patients with curative-intent surgery for PHC is reported to be 45% -88.2%, while portal vein embolization was used in 0% -25.5%(34,35,43,52,79,(86)(87)(88)(89)(90)(92)(93)(94)(95) (table 2). In the present cohort biliary drainage was used in 26% of patients and no patient…”

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Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Dumitraşcu¹,

Brasoveanu²,

Stroescu³

et al. 2018

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Introduction:The knowledge of current approach and outcomes of curative-intent surgery for perihilar cholangiocarcinoma (PHC) has been highlighted in studies of the literature including mainly East Asian and Western patients. Thus, papers presenting the curative-intent surgery in East Europe are scarce. The study aims to present the operative management and outcomes of curative-intent surgery for PHC in an East European institutional experience. Patients and methods: The data of all patients with curative-intent surgery for PHC between 1996 and 2017 were retrospectively reviewed from a prospective maintained electronic database at our Department of Surgery. The assessment was made for the operative management and early and late outcomes. Results: Liver resections were performed in 80.7% of patients, with caudate lobectomies in 64.7% of cases. Vascular resections were performed in 19.4% of patients. Preoperative biliary drainage was performed in 26% of patients. Negative resection margins were obtained in 76.7% of patients. Overall and severe morbidity rates were 57.3% and 24%, respectively. Postoperative bile leak, liver failure and hemorrhage rates were 31.3%, 24.7% and 10%, respectively. The 90-day mortality rate was 6%. The median overall and disease-free survival times were 26 months and 21 months, respectively. Conclusion: The standard approach for curative-intent surgery for PHC implies bile duct resection associated with major hepatectomies, including caudate lobectomy. Expertise in referral surgical centers of East Europe is associated with morbidity, mortality and overall survival rates comparable with those reported in Western centres, despite low rate of preoperative biliary drainage and no use of portal vein embolization. Improvements of preoperative optimization with portal vein embolization and biliary drainage may potentially lead to better early and long-term outcomes.

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Dyna-CT-Based Three-Dimensional Cholangiography in Biliary Duct Assessment of Hilar Cholangiocarcinoma

et al. 2020

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Curative Resection for Hilar Cholangiocarcinoma: Single-Center Experience with Long-Term Follow-Up

Cited by 4 publications

References 4 publications

Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review

Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review

Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Dyna-CT-Based Three-Dimensional Cholangiography in Biliary Duct Assessment of Hilar Cholangiocarcinoma

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