Management of Hilar Cholangiocarcinoma

Tsao, Jane I.; Nimura, Yuji; Kamiya, Junichi; Hayakawa, Naokazu; Kondo, Satoshi; Nagino, Masato; Murakami, Masahiko; Kanai, Masashi; Uesaka, Katsuhiko; Oda, Koji; Rossi, Ricardo L.; Braasch, John W.; Dugan, John M.

doi:10.1097/00000658-200008000-00003

Cited by 230 publications

(42 citation statements)

References 30 publications

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“…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. Ductal resection margin status is an established prognostic indicator,13, 14 and survival following resection in patients with positive ductal margins has generally been deemed unsatisfactory 10, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25. In 2005, Wakai et al26 reported that invasive carcinoma at the ductal resection margins had a strong adverse effect on survival in patients with extrahepatic cholangiocarcinoma, whereas residual carcinoma in situ did not.…”

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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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%

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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“…2 Surgery provides the only chance for cure with varying resectability rates of 25-91% depending on tumour location. [3][4][5][6] However, obtaining a negative resection margin (RM) is a challenge, 7,8 and microscopic (R1) and macroscopic (R2) residual diseases are observed in 20-40% and 4-64%, respectively. [9][10][11][12][13][14][15] Many studies have revealed that positive RM of EHBD cancer is directly associated with high local recurrence (LR) rate.…”

Section: Introductionmentioning

confidence: 99%

Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Kim

Min

et al. 2017

The British Journal of Radiology

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Objective: To evaluate the benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic bile duct (EHBD) cancer. Methods: From 1997 to 2015, 59 patients with EHBD cancer were the subject of this study; 36 patients not undergoing adjuvant treatment after surgery (observation group) and 23 patients receiving adjuvant RT (RT group) were compared. Microscopic residual disease (R1) was in 9 (25%) patients and 5 (22%) patients, and macroscopic residual disease (R2) was in 2 (6%) patients and 6 (26%) patients in the observation and RT groups, respectively. Adjuvant RT was delivered to the tumour bed and regional lymph nodes up to 50.4 Gy (range, 45-61 Gy). Results: With a median follow-up of 19 months, local recurrence was observed in 10 (28%) patients and 2 (9%) patients in the observation and RT groups, respectively. On univariate analysis, the 5-year local recurrence-free survival (LRFS) rates were 50% in the observation group and 54% in the RT group (p 5 0.401).The 5-year overall survival (OS) rates were 29.3% in the observation group and 26.3% in the RT group (p 5 0.602). On multivariable analysis, however, adjuvant RT significantly improved LRFS [hazard ratio (HR), 0.310; 95% confidence interval (CI), 0.100-0.963; p 5 0.043] and had a trend towards increased OS (HR, 0.491; 95% CI, 0.219-1.102; p 5 0.085). Resection margin (RM) status was also correlated with LRFS (HR for R1 6.134, 95% CI 2. and HR for R2 18.551,; p , 0.001) and OS (HR for R1 1.816, 95% CI 0.853-3.867; and HR for R2 3.564, 95% CI 1.175-10.809; p 5 0.054). Conclusion: RM status was a significant prognosticator of EHBD cancer, and adjuvant RT improved local control rate; thereby, survival rate might be increased. Advances in knowledge: The benefit of adjuvant RT in EHBD cancer was demonstrated via comparison with observation group.

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“…These results are comparable with those reported in other studies. 3,25 The concept of the importance of caudate lobe resection in association with hepatectomy in HCCA patients was adopted in recent years as it usually infiltrated with the tumors varying from 48% to 96%. 11,27 The value of this resection is now accepted, with a 5-year survival rate of 46% in those patients who underwent caudate lobe resection in comparison with 12% in patients without caudate lobe resection.…”

Section: Discussionmentioning

confidence: 99%

“…20,28 Most publications advise lymph node dissection at the porta hepatis and around the hepatic artery for staging and disease control. 3,2,29 Our policy was to start with lymph node dissection at the celiac trunk, common hepatic artery, retero-duodenal and porta hepatis. In the literature, different studies have shown that the 5-year survival rate in patients with lymph node metastasis does not exceed 25%.…”

Section: Discussionmentioning

confidence: 99%

“…In the last 20 years the definition of the resectability and standardised opinion has not been agreed upon, especially between Japanese and western authors. 3 Physical status of the patients and liver functions, biliary extend of neoplasm, vascular involvement, presence of lower atrophy, lymph node involvement and presence of distant metastases. All these factors must be taken into consideration before the decision of resection.…”

Section: Assessment Of Resectabilitymentioning

confidence: 99%

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Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

Wahab¹,

Fathy²,

Salah³

et al. 2011

JST

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Background Hilar cholangiocarcinoma (HCCA) is a challenging problem for surgeons because surgery is the only effective therapy for these patients. In this study, we review 15 years of HCCC cases and treatment at a single Egyptian center. Methods From January 1995 to October 2010, 825 patients with HCCC were referred to Gastroenterology Surgical Center, Mansoura University, Egypt. From those 243 underwent potentially curative resection giving respectability rate of 29.4%, and the remaining patients (70.6%) underwent non-surgical treatment because of advanced disease, advanced cirrhosis, poor general condition and distant metastasis and locally advanced diseases. Data were recorded for the 243 cases (subjected to different types of hepatic resection), including demographics, medical history, presenting symptoms, and biochemical, radiological, and pathological parameters. ResultsThe overall resectability rate of the patients studied was 29.4% (243/825). Localized resection, right hepatectomy, or left hepatectomy were completed in 30.5%, 22.6%, and 46.9% respectively, and segment one in 58 % R0 status was achieved in 49.8% of patients. The overall complication rate was 35%. Operative mortality was 6.6% with a five-year survival rate of 16%. Recurrence occurred in 92 (37.8%) the site of recurrence was hepatic (24.3%) and local (13.5%). Resection margin (R0) (P<0.001), lymph node status (P<0.001) (negative), degree of differentiation (P<0.001), segment one resection (P<0.001) (positive), and status of liver (P<0.001) (normal or cirrhotic) predicted statistically higher survival (P<0.001). According to multivariate analysis, R0 lymph node status and well differentiated status. Prediction improved survival among all patients. Conclusion From these case studies, aggressive surgery with caudate lobe resection with normal liver parenchyma may produce better prognoses in patients with resectable HCCA.

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Management of Hilar Cholangiocarcinoma

Cited by 230 publications

References 30 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

Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

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