Surgery for cholangiocarcinoma.
Bile Duct Neoplasms
/ mortality
Cholangiocarcinoma
/ mortality
Drainage
Embolization, Therapeutic
Hepatectomy
Humans
Liver Transplantation
Lymph Node Excision
Neoadjuvant Therapy
Neoplasm Recurrence, Local
Neoplasm Staging
Patient Selection
Randomized Controlled Trials as Topic
Risk Factors
Treatment Outcome
Tumor Burden
cholangiocarcinoma
hepatectomy
klatskin tumor
liver transplantation
surgery
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
16
01
2019
revised:
22
02
2019
accepted:
27
02
2019
pubmed:
8
3
2019
medline:
16
1
2020
entrez:
8
3
2019
Statut:
ppublish
Résumé
Surgical resection is the only potentially curative treatment for patients with cholangiocarcinoma. For both perihilar cholangiocarcinoma (pCCA) and intrahepatic cholangiocarcinoma (iCCA), 5-year overall survival of about 30% has been reported in large series. This review addresses several challenges in surgical management of cholangiocarcinoma. The first challenge is diagnosis: a biopsy is typically avoided because of the risk of seeding metastases and the low yield of a brush of the bile duct. However, about 15% of patients with suspected pCCA are found to have a benign diagnosis after resection. The second challenge is staging; even with the best preoperative imaging, a substantial percentage of patients has occult metastatic disease detected at staging laparoscopy or early recurrence after resection. The third challenge is an adequate volume and function of the future liver remnant, which may require preoperative biliary drainage and portal vein embolization. The fourth challenge is a complete resection: a positive bile duct margin is not uncommon because the microscopic biliary extent of disease may be more extensive than perceived on imaging. The fifth challenge is the high post-operative mortality that has decreased in very high volume Asian centres, but remains about 10% in many Western referral centres. The sixth challenge is that even after a complete resection most patients develop recurrent disease. Recent randomized controlled trials found conflicting results regarding the benefit of adjuvant chemotherapy. The final challenge is to determine which patients with cholangiocarcinoma should undergo liver transplantation rather than resection.
Identifiants
pubmed: 30843343
doi: 10.1111/liv.14089
pmc: PMC6563077
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
143-155Subventions
Organisme : European Network for the Study of Cholangiocarcinoma (ENSCCA)
Pays : International
Organisme : COST Association
ID : CA18122
Pays : International
Informations de copyright
© 2019 The Authors. Liver International published by John Wiley & Sons Ltd.
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