Major Hepatectomy for Hilar Cholangiocarcinoma Type 3 and 4: Prognostic Factors and Longterm Outcomes

Baton, O.; Azoulay, Daniel; Adam, Delvart V. René; Castaing, Denis

doi:10.1016/j.jamcollsurg.2006.10.028

Cited by 109 publications

(100 citation statements)

References 31 publications

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“…Even in high-volume centres, the resectability rate is about 30% of all patients with HCC, with the operative mortality rate ranging from 0% to 15%. After curative resection, the 1-, 3-and 5-year survival rates range from 50% to 70%, 30% to 40%, and 10% to 40%, respectively ( Figure 1) [14,20,[43][44][45][46][47][48] . The major determinants of resectability include ex- tent of vascular invasion, hepatic lobar atrophy, amount of hepatic parenchyma involved, and extent of spread within the biliary tree.…”

Section: Staging and Resectabilitymentioning

confidence: 99%

“…Published 5-year survival rates range from 25% to 40% in recent series, and, even, it has been reported that many clinical and histological factors have a positive impact on long-term outcome, including negative histologic margin status [99,100] , concomitant hepatic resection [30] , absence of nodal involvement [14,23,48,101] , low TNM status [36] , welldifferentiated tumor grade [68] , papillary tumor morphology [36,44,80] , and lack of perineural invasion [23] . Complete resection with negative histologic margins is the only modifiable factor and, for that reason, the primary aim of surgical therapy.…”

Section: Outcome Of Resectionmentioning

confidence: 99%

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Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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vein embolization and staging laparoscopy should be considered in selected patients. Additional evidence is needed to fully define the role of orthotopic liver transplant. Portal and lymph node involvement worsen the prognosis and long-term survival, and surgery is the only option that can lengthen it. Improvements in adjuvant therapy are essential for improving long-term outcome. Furthermore, the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option, because operated patients have a longer survival rate than those who not undergo surgery. INTRODUCTIONCarcinomas arising from the confluence of the hepatic ducts were first described by Altemeier et al [1] . Klatskin [2] Alejandro Serrablo, Luis Tejedor Outcome of surgical resection in Klatskin tumors TOPIC HIGHLIGHT AbstractCholangiocarcinomas are the second most frequent primary hepatic malignancy, and make up from 5% to 30% of malignant hepatic tumours. Hilar cholangiocarcinoma (HCC) is the most common type, and accounts for approximately 60% to 67% of all cholangiocarcinoma cases. There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease. Neither the extension of resection, according to the sort of HCC, is a closed topic. Some authors defend limited resection (mesohepatectomy with S1, S1 plus S4b-S5, local excision for papillary tumours, etc .) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure. As there is not an ideal adjuvant therapy, R1 resection can be justified to prolong the survival rate. Morbidity and mortality rates changed along the last decade, but variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Conclusion: Surgical resection continues to be the main treatment of HCC. Negative resection margins achieved with major hepatic resections are associated with improved outcome. Preresectional management with biliary drainage, portal José M Ramia, MD, PhD, Series Editor

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Section: Staging and Resectabilitymentioning

confidence: 99%

Section: Outcome Of Resectionmentioning

confidence: 99%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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“…Lymph node metastasis is a prognostic factor in patients with biliary or pancreas carcinoma who undergo surgical resection [1,2]. Preoperatively, node status determined by image studies offers useful information for assessment of node metastasis and choice of radical surgery.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Diagnosis of Lymph Node Metastasis in Biliary and Pancreatic Carcinomas: Evaluation of the Combination of Multi-detector CT and Serum CA19-9 Level

et al. 2010

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“…Hepatic hilar bile duct cancer requires extended hepatectomy as a curative intervention and therefore has a high mortality rate [7, 8]. A common practice in the planning for an extended left hepatic lobectomy is to select operative steps for a less risky hepatectomy with reduced intraoperative bleeding [9].…”

Section: Discussionmentioning

confidence: 99%

Extended Left Hepatic Lobectomy for Hepatic Hilar Bile Duct Cancer: A Novel Surgical Procedure in Which the Right Hepatic Duct Is Transected before the Hepatoduodenal Ligament Is Skeletonized

Miyazawa

Aikawa²,

Okada³

et al. 2009

Dig Surg

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As a general principle, the procedure of isolating a cancer region from surrounding tissues (skeletonization) is not taken until the last stage of a cancer operation. This principle is often disregarded in surgery for cancers of the hepatic hilar duct, however, as it may be mandatory to skeletonize the region before resecting the liver. Our group invented ‘extended left hepatic lobectomy’, a new surgical procedure for hepatic hilar bile duct cancer, in which we isolate the liver and transect the right hepatic duct before skeletonizing the cancer region in the hepatoduodenal ligament.

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Major Hepatectomy for Hilar Cholangiocarcinoma Type 3 and 4: Prognostic Factors and Longterm Outcomes

Cited by 109 publications

References 31 publications

Outcome of surgical resection in Klatskin tumors

Outcome of surgical resection in Klatskin tumors

Preoperative Diagnosis of Lymph Node Metastasis in Biliary and Pancreatic Carcinomas: Evaluation of the Combination of Multi-detector CT and Serum CA19-9 Level

Extended Left Hepatic Lobectomy for Hepatic Hilar Bile Duct Cancer: A Novel Surgical Procedure in Which the Right Hepatic Duct Is Transected before the Hepatoduodenal Ligament Is Skeletonized

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