Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type III and IV

Cheng, Qiang; Yi, Bin; Wang, J.-H.; Jiang, Xiaoqing; Luo, Xiangji; Liu, C.; Ran, Rongzhen; Yan, Pan; Zhang, B.-H.

doi:10.1016/j.ejso.2012.08.009

Cited by 67 publications

(65 citation statements)

References 26 publications

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“…The 24 articles finally included in the meta‐analysis contained 4599 patients (range 42–457 per study) who had undergone attempted curative resection for hilar cholangiocarcinoma. Prognostic factors were reported variably across the studies ( Table S1, supporting information).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Bird

McKenna

Dodd

et al. 2018

British Journal of Surgery

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Bird

McKenna

Dodd

et al. 2018

British Journal of Surgery

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“…With these principles in mind, any of the following criteria categorize a non‐metastatic hilar cancer as unresectable: (i) bilateral segmental ductal extension; (ii) unilateral atrophy with either contralateral segmental ductal or vascular inflow involvement, and (iii) unilateral segmental ductal extension with contralateral vascular inflow involvement. The improved margin‐negative resection rates and survival associated with caudate lobectomy for patients with Bismuth–Corlette type III and IV lesions have been demonstrated in several retrospective series . Although some authors have described acceptable outcomes in patients undergoing portal vein resection and reconstruction in the setting of main portal vein involvement, these operations should be undertaken by only the most experienced centres with the appropriate hepatobiliary and vascular surgery expertise.…”

Section: Surgical Treatment Of Hilar CCmentioning

confidence: 99%

Hilar Cholangiocarcinoma: expert consensus statement

Mansour

Aloia

Crane

et al. 2015

HPB

342

294

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An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists met on 15 January 2014 to review current evidence on the management of hilar cholangiocarcinoma in order to establish practice guidelines and to agree consensus statements. It was established that the treatment of patients with hilar cholangiocarcinoma requires a coordinated, multidisciplinary approach to optimize the chances for both durable survival and effective palliation. An adequate diagnostic and staging work-up includes high-quality cross-sectional imaging; however, pathologic confirmation is not required prior to resection or initiation of a liver transplant trimodal treatment protocol. The ideal treatment for suitable patients with resectable hilar malignancy is resection of the intra- and extrahepatic bile ducts, as well as resection of the involved ipsilateral liver. Preoperative biliary drainage is best achieved with percutaneous transhepatic approaches and may be indicated for patients with cholangitis, malnutrition or hepatic insufficiency. Portal vein embolization is a safe and effective strategy for increasing the future liver remnant (FLR) and is particularly useful for patients with an FLR of <30%. Selected patients with unresectable hilar cholangiocarcinoma should be evaluated for a standard trimodal protocol incorporating external beam and endoluminal radiation therapy, systemic chemotherapy and liver transplantation. Post-resection chemoradiation should be offered to patients who show high-risk features on surgical pathology. Chemoradiation is also recommended for patients with locally advanced, unresectable hilar cancers. For patients with locally recurrent or metastatic hilar cholangiocarcinoma, first-line chemotherapy with gemcitabine and cisplatin is recommended based on multiple Phase II trials and a large randomized controlled trial including a heterogeneous population of patients with biliary cancers.

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“…In univariate analysis, the effect of R0 resection on OS was not statistically significant, but it was confirmed as independent predictive variable in multivariate analysis. In fact, several studies have suggested R0 resection as the most important factor affecting prognosis[18-20]. …”

Section: Discussionmentioning

confidence: 99%

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

Jung¹,

Lee²,

Lee³

et al. 2017

WJG

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AIMTo clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.

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Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type III and IV

Cited by 67 publications

References 26 publications

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Hilar Cholangiocarcinoma: expert consensus statement

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

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