Current Management of Perihilar Cholangiocarcinoma and Future Perspectives

Lewis, Heather L.; Rahnemai‐Azar, Amir A.; Dillhoff, Mary; Schmidt, Carl; Pawlik, Timothy M.

doi:10.21614/chirurgia.112.3.193

Cited by 34 publications

(24 citation statements)

References 95 publications

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“…Curative operative procedure in perihilar CCA aims to achieve an R0 tumor resection [18]. Tumor staging, not only of the vascular extension but also of the intraductal extension evaluated in BCC, is essential to achieve this purpose.…”

Section: Discussionmentioning

confidence: 99%

Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors

Pereira

Santos

Morais

et al. 2020

Dig Dis

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Objectives: Peroral cholangioscopy (POC) has shown to be a useful diagnostic procedure in the evaluation of biliary strictures; however, data regarding its role on preoperative staging are scarce. The aim of this study was to evaluate POC role in the diagnosis and preoperative intraductal staging of perihilar cholangiocarcinoma (CCA). Methods: Retrospective study that included all patients who underwent POC with SpyGlass TM Direct Visualization System for the diagnosis of biliary strictures or for preoperative evaluation of extrahepatic biliary tumors, between 2015 and 2019, in a single tertiary center. Results: Forty-three patients were included, 63% male with a median age of 62 years. Thirty-eight (88.3%) underwent POC due to indeterminate biliary strictures, 3 (7%) due to bile duct filling defect, and 2 (4.7%) for intraductal staging of perihilar CCA. In the follow-up, a final diagnosis of malignancy was established in 56% of the patients. Visual impression accuracy with SpyGlass was 95.1% (with 100% sensitivity and 89.5% specificity). SpyBite biopsies accuracy was 80.5% (63.6% sensitivity and 100% specificity). In the 19 patients with a final perihilar CCA diagnosis, intraductal evaluation with SpyGlass altered anatomic classification (Bismuth-Corlette) defined by previous imagiologic findings in 8 (42.1%) patients. Alteration in anatomic classification changed therapeutic approach in 4 (21%). Conclusions: POC use for evaluating intraductal spread in potentially resectable perihilar CCA can detect more extensive and change surgical management. In the future, preoperative staging of perihilar CCA with POC combined with imagiologic evaluation of vascular extension of the lesions may optimize surgical results.

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Section: Discussionmentioning

confidence: 99%

Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors

Pereira

Santos

Morais

et al. 2020

Dig Dis

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“…The role of preoperative biliary drainage in jaundiced patients with hilar cholangiocarcinoma (HCCA) is an important clinical topic . Preoperative biliary drainage may improve hepatic function, optimize nutritional parameters, and reduce the risk of cholangitis and post‐operative liver failure .…”

Section: Introductionmentioning

confidence: 99%

Oncologic effects of preoperative biliary drainage in resectable hilar cholangiocarcinoma: Percutaneous biliary drainage has no adverse effects on survival

Zhang

Beal

Merath

et al. 2017

Journal of Surgical Oncology

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The median decrease in total bilirubin levels after biliary drainage was similar comparing PTBD (n = 104) versus EBD (n = 92) (mg/dL, 4.9 vs 4.9, P = 0.589) before surgery. There was no difference in baseline demographic characteristics, type of surgical procedure performed, final AJCC tumor stage or postoperative morbidity among patients who underwent EBD only versus PTBD (all P > 0.05). Patients who underwent PTBD versus EBD had a comparable long-term DSS (median, 43.7 vs 36.9 months, P = 0.802) and RFS (median, 26.7 vs 24.0 months, P = 0.571). The overall pattern of recurrence relative to regional or distant disease was also the same among patients undergoing PTBD and EBD (P = 0.669) CONCLUSIONS: Oncologic outcomes including DSS and RFS were similar among patients who underwent PTBD versus EBD with no difference in tumor recurrence location.

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“…This approach was furthermore adopted in Western surgical centres (42,43). Preoperative biliary drainage of the future liver remnant and portal vein embolization are the main tool to reduce the risk of post-hepatectomy liver failure in these patients (28,43,44).…”

Section: Discussion Discussionmentioning

confidence: 99%

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

SGO

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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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Current Management of Perihilar Cholangiocarcinoma and Future Perspectives

Cited by 34 publications

References 95 publications

Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors

Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors

Oncologic effects of preoperative biliary drainage in resectable hilar cholangiocarcinoma: Percutaneous biliary drainage has no adverse effects on survival

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

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