Issues in Surgery for Hilar Cholangiocarcinoma

Abstract

Hilar cholangiocarcinoma provides a surgical challenge. Successful outcome depends upon preoperative imaging, appropriate use of biliary drainage and portal vein embolisation as well as appropriate liver resection with caudate lobe excision and nodal clearance.Keywords Biliary tract cancer . Biliary stricture . Liver surgery Hilar cholangiocarcinoma (HCCC) is a rare tumour involving the hepatic ducts at the liver hilum. The surgical excision of these tumours provides a particular challenge to HPB surgeons as the portal vein and hepatic artery are closely related to the bile duct and varying amounts of liver needs to be excised to ensure complete clearance. The surgery is anatomically challenging. Success rates are higher than for most HPB tumours such as pancreatic adenocarcinomas, and an R0 resection can achieve excellent cure rates in 37-50% of cases [1][2][3][4]. Preoperative AssessmentThe key to successful resection of these tumours is preoperative assessment and optimization of these patients. As the initial presentation is with obstructive jaundice, ultrasonography is often the primary modality of evaluation. This, however, does not provide enough information to proceed. The initial evaluation should be by a triple-phase CT scan of the liver with an arteriographic phase, venous phase (Fig.

Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents

“…However, surgery and anesthesia can cause physical and psychological trauma, whereas there was no significant improvement in the prognosis of patients. [ 14 , 15 ] Additionally, geriatric cases and patients with poor systemic conditions are unable to tolerate laparotomy. Thus, we recommended the minimally invasive biliary stenting procedure for drainage in some patients.…”