Surgical Treatments of Hepatobiliary Cancers

Abstract

Hepatobiliary cancers which include hepatocellular carcinoma (HCC) and biliary tract cancers (i.e., cholangiocarcinoma and gallbladder carcinoma) are associated with significant morbidity and mortality based on the stage of the disease at presentation. With improved screening for hepatobiliary malignancies in patients with risk factors and with widespread use of laparoscopic cholecystectomy, hepatobiliary malignancies, including incidental diagnosis of gallbladder carcinoma, are on the rise. Definitive treatment of hepatobiliary malignancies include surgical resection, ablation, and liver transplantation. However, management of these cancers is challenging due to the complex hepatobiliary anatomy and the need for meticulous perioperative management especially in patients with advanced liver disease. The management and prognosis of hepatobiliary malignancies vary widely based on the stage of presentation, with surgical options providing the possibility of definitive cure in patients presenting with early‐stage disease. Surgical resection for HCC results in good outcomes if performed in ideal candidates. For patients with early HCC who are not candidates for surgical resection, ablation and liver transplantation should be considered. Similarly, surgical resection is also the definitive treatment for biliary tract cancers, and liver transplantation can be curative in selected patients with perihilar cholangiocarcinoma after neoadjuvant chemoradiotherapy. The role of routine adjuvant chemotherapy and radiotherapy is not clearly established, but adjuvant therapies can offer better outcomes in patients with advanced disease at presentation. Outcomes of surgical management of hepatobiliary cancers seem to be improving. Given the complex decision‐making process involved, multidisciplinary evaluation is essential to provide and coordinate the best treatments for these patients.

Hypoxia-Inducible Ubiquitin Specific Peptidase 13 Contributes to Tumor Growth and Metastasis via Enhancing the Toll-Like Receptor 4/Myeloid Differentiation Primary Response Gene 88/Nuclear Factor-κB Pathway in Hepatocellular Carcinoma

“…HCC commonly occurs under the conditions of hepatitis B/C (HBV/HCV)-mediated chronic inflammation and metabolic syndrome (Han et al, 2020;McGlynn et al, 2020). Currently, only one third of cases are eligible for curative treatments, and the therapeutic strategies for advanced HCC are limited, which leads to the poor prognosis of patients (Gunasekaran et al, 2020). Therefore, there is an urgent need to thoroughly understand the molecular mechanisms involved in the occurrence and progression of HCC.…”

Transcription factor E2F4 is an indicator of poor prognosis and is related to immune infiltration in hepatocellular carcinoma

“…HCC is a worldwide threat with significant morbidity and mortality based on the stage of the disease at presentation 29 . Current treatment strategies such as resection, chemotherapy, radiation, immunotherapy, and gene therapy are improving, but recurrence of illness due to therapy resistance results in high mortality.…”

Gut Microbiome Analysis As A Non-Invasive Tool for the Early Diagnosis of Cholangiocarcinoma

“…Correlations among tumor stage, tumor subtype, clinical characteristics, and the gut microbiota composition Cancer classi cation and staging play a pivotal role in therapy and prognosis [30]. Here, we compared the microbial compositions between the different CCA subtype and stage (Fig.…”