Background. This study is aimed at investigating the feasibility and safety of the laparoscopic radical resection for treating type III and IV hilar cholangiocarcinoma (III/IV Hilar C). Methods. Six patients with III/IV Hilar C were enrolled in our hospital. All patients underwent total laparoscopic surgery, including basic surgery (laparoscopic gallbladder, hilar bile duct, and common bile duct resection and hepatoduodenal ligament lymph node dissection) combined with left hepatic and caudate lobe resection/portal resection. The tumor size, operation time, intraoperative blood loss, and postoperative complications were observed. The follow-up of the patients after discharge was recorded. Results. Surgery was successfully completed in 6 patients. We found that the tumor size of 6 patients ranged from 1.5 to 3.6 cm, with 4 lymph nodes. The operation time was 540-660 minutes, and the blood loss was 300-500 ml. One patient developed bile leakage after surgery, healed within 2 weeks after drainage. The postoperative hospital stay was 16 (13-24) days. There were 4 cases of negative bile duct margin tumor, 1 case was positive, and 1 case was not reported. All 6 patients were discharged smoothly without perioperative death. Regular examinations were conducted every 3 months after discharge, and the median duration was 7 months. Only 1 patient had a marginal dysplasia, and 5 patients had no obvious signs of recurrence. Conclusions. Application of laparoscopic radical resection for III/IV Hilar C is safe and feasible and has good short-term efficacy with adequate preoperative evaluation, appropriate case selection, and precise operative strategy.
Background
The World Health Organization's updated classification of digestive system neuroendocrine tumors in 2010 first proposed the classification of mixed adenoneuroendocrine carcinoma (MANEC). The incidence of biliary malignant tumors with neuroendocrine tumors accounts for less than 1% of all neuroendocrine tumors. Moreover, the incidence of hilar bile duct with MANEC is very rare.
Case presentation
A 65-year-old female patient came to our hospital for repeated abdominal pain for more than 4 months and skin sclera yellow staining for 1 week. Contrast-enhanced computed tomography imaging and magnetic resonance results suggested a hilar tumor for Bismuth-Corlette Type II. The patient underwent radical surgery for hilar cholangiocarcinoma. Finally, the patient was diagnosed with hilar bile duct MANEC, staged 1 (pT1N0M0) based on the eighth edition of the AJCC. Histopathology showed that the tumor was a biliary tumor with both adenocarcinoma and neuroendocrine carcinoma. No evidence of recurrence and metastasis after 20 months of follow-up.
Conclusions
We first reported a MANEC that originated in the hilar bile duct. As far as we known, there were few reports of biliary MANEC, and the overall prognosis was poor. We also found that the higher the Ki-67 index, the worse the prognosis of this type of patient. Radical surgery is the most effective treatment.
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