Resection for intrahepatic cholangiocellular cancer: new advances

Abstract

Intrahepatic cholangiocarcinoma (ICC) is the second most prevalent primary liver neoplasm after hepatocellular carcinoma (HCC), corresponding to 10% to 15% of cases. Pathologies that cause chronic biliary inflammation and bile stasis are known predisposing factors for development of ICC. The incidence and cancer-related mortality of ICC is increasing worldwide. Most patients remain asymptomatic until advance stage, commonly presenting with a liver mass incidentally diagnosed. The only potentially curative treatment available for ICC is surgical resection. The prognosis is dismal for unresectable cases. The principle of the surgical approach is a margin negative hepatic resection with preservation of adequate liver remnant. Regional lymphadenectomy is recommended at time of hepatectomy due to the massive impact on outcomes caused by lymph node (LN) metastasis. Multicentric disease, tumor size, margin status and tumor differentiation are also important prognostic factors. Staging laparoscopy is warranted in high-risk patients to avoid unnecessary laparotomy. Exceedingly complex surgical procedures, such as major vascular, extrahepatic bile ducts and visceral resections, ex vivo hepatectomy and autotransplantation, should be implemented in properly selected patients to achieve negative margins. Neoadjuvant therapy may be used in initially unresectable lesions in order to downstage and allow resection. Despite optimal surgical management, recurrence is frustratingly high. Adjuvant chemotherapy with radiation associated with locoregional treatments should be considered in cases with unfavorable prognostic factors. Selected patients may undergo re-resection of tumor recurrence. Despite the historically poor outcomes of liver transplantation for ICC, highly selected patients with unresectable disease, especially those with adequate response to neoadjuvant therapy, may be offered transplant. In this article, we reviewed the current literature in order to highlight the most recent advances and recommendations for the surgical treatment of this aggressive malignancy.

Long non‐coding RNA MIR22HG inhibits cell proliferation and migration in cholangiocarcinoma by negatively regulating the Wnt/β‐catenin signaling pathway

“…According to recent epidemiological research, the morbidity and mortality of CCA are increasing rapidly worldwide . Despite mounting advancement in therapeutic regimes for CCA, such as surgery, radiotherapy and chemotherapy, there remains high postoperative recurrence rate and low 5‐year survival in CCA patients . Therefore, it is necessary to understand the molecular mechanism of CCA carcinogenesis and progression, which will help with respect to identifying novel diagnostic and therapeutic targets for CCA patients.…”

Adjuvant transarterial chemoembolization following radical resection for intrahepatic cholangiocarcinoma: A multi-center retrospective study

“…The prognosis of ICC after radical resection remains poor [5,7,21], and strategies intended to reduce early recurrence and improve the long-term prognosis are still badly warranted. p-TACE has been tried with the aim of anti-recurrence, but its efficacy remains controversial [14][15][16][17][18][19].…”

“…Radical resection is still the first-line treatment for patients with ICC [5][6][7], although half of the patients have lost the chances of resection at diagnosis [3,4]. However, the median OS of ICC after radical resection has been reported to be 21.0-39.0 months [10,22,23], which is far from satisfactory.…”

“…The prognosis remains poor, partly because approximately half of the ICC patients have lost the chances of surgery at diagnosis [3,4]. Currently, radical resection remains the most efficient strategy for ICC [5][6][7][8], but the 5-year overall survival (OS) after radical resection is 20%-35% [9,10]. Hence, postoperative adjuvant treatments are badly warranted to improve the prognosis of ICC.…”

Robotic Surgery: A Boon or a Bane to Medical Science

“…A dedicated robotic team is essential to reduce complications. Patient's selection, surgical positioning, mentorship training, and avoiding long-lasting procedures are essential to prevent RAL-related complications [10].…”