Surgical management of hilar cholangiocarcinoma: Controversies and recommendations

Jena, Suvendu Sekhar; Mehta, Naimish; Nundy, Samiran

doi:10.14701/ahbps.23-028

Cited by 6 publications

(1 citation statement)

References 98 publications

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“…Therefore, thorough lymph node dissection is essential for these patients[ 10 ]. It is particularly important to optimize the technology used for modular and en bloc clearance of the hepatic hilar region[ 11 , 12 ]; (3) A high rate of surgical margin positivity: Due to the particularity of the tumor location and invasiveness, the rate of surgical margin positivity is relatively high in Bismuth-Corlette type III and IV HCCA patients, which further increases the risk of postoperative recurrence[ 13 , 14 ]; and (4) A high risk of intraoperative bleeding: Due to the extensive vascular network in the hepatic hilar area, complex anatomical variation factors, and the requirement for extensive hepatectomy, the risk of intraoperative bleeding is high[ 15 , 16 ]. Therefore, strict intraoperative vascular protection and control are essential in Bismuth-Corlette type III and IV HCCA patients.…”

Section: Discussionmentioning

confidence: 99%

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

Hu,

Wang,

Pan

et al. 2024

World J Gastrointest Surg

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BACKGROUND In recent years, pure laparoscopic radical surgery for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, but the surgical strategy and safety are still worthy of further improvement and attention. AIM To summarize and share the application experience of the emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV. METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed. RESULTS Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of “hepatic hilum area dissection priority, liver posterior separation first”. The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications. CONCLUSION The emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.

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Section: Discussionmentioning

confidence: 99%

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

Hu,

Wang,

Pan

et al. 2024

World J Gastrointest Surg

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Liver transplantation for treatment of nonresectable primary and secondary liver malignancies

Guba,

Werner

2024

Chirurgie

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Proposal of a modified classification for hilar cholangiocarcinoma

Xiang,

Chen

2023

Oncol Transl Med

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Hilar cholangiocarcinoma is a malignant tumor that originates from the left and right hepatic ducts and their confluence. It is highly malignant and associated with a poor prognosis. Surgical resection is the only available curative treatment option. A scientific classification system can aid in the preoperative assessment of resectability and guide the development of appropriate surgical strategies. Several classification systems are available, with the Bismuth-Corlette (BC) classification being the earliest and most widely used. Similar to many other classifications, the BC classification relies on the secondary branching of the bile ducts as an important anatomical landmark, making it unsuitable for cases with variations in the bile duct anatomy. With advances in understanding the hepatic plate and anatomical structures at the hilum, the secondary bile ducts are no longer considered important anatomical landmarks. Therefore, modifications to the BC classification are needed to align with modern anatomical improvements and advancements in surgical techniques. Herein, we propose a modification to the BC classification. In this new system, the boundary of the hilar plate is considered as limit of the proximal ductal margin and used as an anatomical landmark, rather than the concept of “secondary bile ducts” in the BC classification.

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Surgical management of hilar cholangiocarcinoma: Controversies and recommendations

Cited by 6 publications

References 98 publications

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma

Liver transplantation for treatment of nonresectable primary and secondary liver malignancies

Proposal of a modified classification for hilar cholangiocarcinoma

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