Transhepatic hilar approach for Bismuth types III and IV perihilar cholangiocarcinoma with long-term outcomes

Xu, Xingwei; Yang, Linhua; Chen, Wei; He, Min

doi:10.1177/03000605211008336

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…R0 resection is an independent risk factor for HCCA 10 , 45 . The length of the tumor-free resection margin depends on the infiltration pattern and depth of the bile duct in HCCA.…”

Section: Resultsmentioning

confidence: 98%

The value of total caudate lobe resection for hilar cholangiocarcinoma

Wang,

Xiong,

et al. 2023

International Journal of Surgery

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Hilar cholangiocarcinoma is widely considered to have poor prognosis. In particular, combined caudate lobe resection (CLR) as a strategy for radical resection in hilar cholangiocarcinoma is important for improving the R0 resection rate. However, the criteria for R0 resection, necessity of CLR, optimal extent of hepatic resection, and surgical approach are still controversial. This review aimed to summarize the findings and discuss the controversies surrounding caudate lobe resection. Numerous clinical studies have shown that combined CLR treatment for hilar cholangiocarcinoma improves the R0 resection rate and postoperative survival time. Whether surgery for Bismuth type I or II is combined with CLR depends on the pathological type. Considering the anatomical factors, total rather than partial caudate lobe resection is recommended to achieve a higher R0 resection rate. In the resection of hilar cholangiocarcinoma, a proximal ductal margin ≥ 10 mm should be achieved to obtain a survival benefit. Although there is no obvious boundary between the right side (especially the paracaval portion) and right posterior lobe of the liver, Peng’s resection line can serve as a reference marker for right-sided resection. Laparoscopic resection of the caudate lobe may be safer, more convenient, accurate, and minimally invasive than open surgery, but it needs to be completed by experienced laparoscopic doctors.

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“…R0 resection is an independent risk factor for HCCA 10 , 45 . The length of the tumor-free resection margin depends on the infiltration pattern and depth of the bile duct in HCCA.…”

Section: Resultsmentioning

confidence: 98%

The value of total caudate lobe resection for hilar cholangiocarcinoma

Wang,

Xiong,

et al. 2023

International Journal of Surgery

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“…Several previous studies revealed that the prognosis of HCCA resection is affected by multiple factors, including age at time of surgery, preoperative biliary drainage, presence or absence of radical resection, resection margin status, tumor markers, pathological type, lymph node metastasis, and postoperative adjuvant therapy [23][24][25][26][27] . The present study combined clinical practice parameters and Cox univariate and multivariate regression analysis to screen the effect of these variables.…”

Section: Discussionmentioning

confidence: 99%

Survival analysis of laparoscopic surgery and open surgery for hilar cholangiocarcinoma: a retrospective cohort study

Yin

Tao

Xian

et al. 2023

Preprint

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Purpose This study compared the clinical efficacy and safety of laparoscopic versus open resection for hilar cholangiocarcinoma (HCCA) and analyzed potential prognostic factors.Methods The study included patients who underwent HCCA resection at our center from March 2012 to February 2022. Perioperative complications and postoperative prognosis were compared between the laparoscopic surgery (LS) and open surgery (OS) groups.Results After screening 313 HCCA patients, 68 patients were eligible for the study in the LS group (n = 40) and OS group (n = 28). Kaplan-Meier survival curve analysis revealed that overall survival > 2 years and 3-year disease-free survival (DFS) were more common in the LS than OS group, but the rate of 2-year DFS was lower in the LS group than OS group. Cox multivariate regression analysis revealed age (< 65 years), radical resection, and postoperative adjuvant therapy were associated with reduced risk of death (hazard ratio [HR] = 0.380, 95% confidence interval [CI] = 0.150–0.940, P = 0.036; HR = 0.080, 95% CI = 0.010–0.710, P = 0.024 and HR = 0.380, 95% CI = 0.150–0.960, P = 0.040), whereas preoperative biliary drainage was an independent factor associated with increased risk of death (HR = 2.810, 95% CI = 1.130–6.950, P = 0.026). Perineuronal invasion was identified as an independent risk factor affecting DFS (HR = 5.180, 95% CI = 1.170–22.960, P = 0.030).Conclusions Compared with OS, laparoscopic HCCA resection does not significantly differ in terms of clinical efficacy. Age (< 65 years), radical resection, and postoperative adjuvant therapy reduce the risk of death, and preoperative biliary drainage increases the risk of death.

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“…Recently, neoadjuvant chemotherapy combined with liver transplantation has made great progress in unresectable Bismuth type III PCC patients, which can significantly improve their 5-year survival rate [13]. For the selection of Bismuth type III and IV surgical approaches, studies have shown that the hilar approach may be superior to the conventional approach because the hilar approach can obtain a higher negative margin rate, higher survival rate and lower surgical mortality rate [21][22][23].…”

Section: Bismuth-corlette Typementioning

confidence: 99%

The pros and cons of the PCC staging system to guide surgical resectability and prognosis

Liu¹,

Song²,

Shakoor³

et al. 2022

J. Cancer

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Perihilar cholangiocarcinoma (PCC) is a malignant mass originating from the bile ducts. There is currently no unified treatment plan, and there are various treatment methods applied in clinical practice, as well as several different staging and typing systems to guide resectability, prognosis and survival prediction. The choice of treatment for PCC is closely related to the stage of the tumor. Accurate preoperative staging is necessary for correct resectability assessment and the selection of a reasonable treatment plan and surgical method; similarly, accurate postoperative pathological staging is necessary to guide further treatment and judgment of the patient's prognosis. A universally accepted staging system facilitates the comparison of cases between different centers, but there is much debate about the classification and staging of PCC. At present, the existing staging systems include the Bismuth-Corlette classification, AJCC/UICC TNM staging, modified T staging, Gazzaniga staging, JSBS staging, and Mayo staging. Each system has advantages, but there is no comprehensive guide for tumor resectability, prognosis, and survival. In this paper, the pros and cons of the different systems for staging PCC in terms of resectability, prognosis and survival prediction are discussed.

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Transhepatic hilar approach for Bismuth types III and IV perihilar cholangiocarcinoma with long-term outcomes

Cited by 4 publications

References 30 publications

The value of total caudate lobe resection for hilar cholangiocarcinoma

The value of total caudate lobe resection for hilar cholangiocarcinoma

Survival analysis of laparoscopic surgery and open surgery for hilar cholangiocarcinoma: a retrospective cohort study

The pros and cons of the PCC staging system to guide surgical resectability and prognosis

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