Surgical management of hilar cholangiocarcinoma at Memorial Sloan Kettering Cancer Center

Abstract

Hilar cholangiocarcinoma, which represents approximately 60% of biliary tract malignancies, is increasing in incidence and presents an ongoing challenge for patients and hepatobiliary surgeons. Although the majority of patients present with advanced disease, the remaining minority of patients are best treated with surgical resection or transplant. Transplant is typically reserved for locally unresectable tumors often in the setting of underlying hepatic dysfunction and will not be discussed herein. This review, therefore, focuses on oncological resection and the strategies implemented for the treatment of hilar cholangiocarcinoma at a quaternary referral center, including preoperative considerations such as patient selection and optimization of the future liver remnant, nuances to the operative approach for these tumors such as resection under low central venous pressure and management of the bile duct, as well as postoperative management.

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

“…The most frequent etiology of malignant hilar biliary obstruc tion is CCC. Malignant obstructions at the liver hilum is usually more difficult to treat, and although surgical resection is the only curative option for CCC, most patients present in advances stages of disease and are not candidates for curative treatment (119,120) . The Bismuth-Corlette classification system (FIGURE 5) provides an anatomic description of the tumor location and its longitudinal ex tension into the biliary tree and is recommended in clinical practice to guide therapy (121) .…”

Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center.

“…However, radical resection with a negative margin is extremely challenging. The standard operations for resectable HC include extended liver resections in conjunction with extrahepatic bile duct resection, hepatoduodenal lymphadenectomy, caudate lobectomy and bilioenteric anastomosis [ 3 , 10 ]. Increasing evidence has demonstrated that this ‘‘aggressive’’ surgical strategy, although technically challenging, has increased the rate of curative resection and long-term survival.…”

“…Radical resection has been well recognized as the most effective treatment for HC and is also the only choice that confers long-term survival [ 8 – 10 ]. However, curative surgical resection with negative margins can pose great challenges due to the involvement of the biliary confluence, including the right and left hepatic ducts, which are in close proximity to the portal vein, hepatic artery, and liver parenchyma [ 11 ].…”

Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

“…A study performed at Memorial Sloan Kettering Cancer Center has suggested that in patients with jaundice and future liver remnant volume ≥ 30% preoperative biliary drainage does not appear to improve perioperative outcomes (50). In current practice of the aforementioned surgical centre, elective preoperative biliary drainage is used in patients with resection for PHC, only when the future liver remnant volume is less than 40% (53).…”