Untitled

Kawasaki, Seiji; Imamura, Hiroshi; Kobayashi, Akira; Noike, Terumasa; Miwa, Shiro; Miyagawa, Shinichi

doi:10.1097/00000658-200307000-00011

Cited by 51 publications

(71 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirdly, the potential impact of PVE on ductal tumor progression has not been defined. In addition, only a limited reduction in postoperative liver failure rate has been reported after PVE in patients with HCCA [18,19], and excellent results have been obtained in a series of radical HCCA resections without the use of preoperative PVE [20]. In the present series, preoperative PVE was applied in 2 (5%) patients undergoing extended right hemihepatectomy.…”

Section: Discussionmentioning

confidence: 88%

Extent of Liver Resection for Hilar Cholangiocarcinoma (Klatskin Tumor): How Much Is Enough?

Gulik¹,

Ruys²,

Busch³

et al. 2011

Dig Surg

View full text Add to dashboard Cite

Background: Hilar resection in combination with extended liver resections has resulted in a higher rate of R0 resections and increased survival in patients with hilar cholangiocarcinoma (HCCA). This aggressive surgical approach is, however, associated with high rates of operative morbidity and mortality, largely due to postresectional liver failure. We previously reported a series after resection of HCCA in which R0 resection rate was 59% with a mortality rate of 10%. In this study, we assessed mortality of extended liver resections after optimizing liver functional reserve and application of parenchyma-sparing techniques. Methods: From 2008 until June 2010, 41 consecutive patients underwent resection on the suspicion of HCCA. Preoperative workup included staging laparoscopy, preoperative biliary drainage, assessment of volume/function of future remnant liver and radiation therapy to prevent seeding metastases. Modified right and left extended hemihepatectomies were performed preserving parts of segments 4 and 8, respectively, while pursuing complete excision of the tumor. Outcomes of resection were evaluated. Results: The majority of resections (78%) were performed for Bismuth type III–IV tumors. Preoperative biliary drainage was undertaken in 37 (90%) patients. Hilar resection in combination with liver resection was performed in 35 (85%) patients. Of these resections, 61% were modified extended resections including central liver resections. The R0 resection rate was 92%. Postoperative morbidity and mortality rates were 54 and 7%, respectively. Conclusion: Strategies to optimize liver function and to reduce removal of functional liver parenchyma were associated with a decrease in mortality (7%) while undertaking extended resection for HCCA with an R0 resection rate of 92%.

show abstract

Section: Discussionmentioning

confidence: 88%

Extent of Liver Resection for Hilar Cholangiocarcinoma (Klatskin Tumor): How Much Is Enough?

Gulik¹,

Ruys²,

Busch³

et al. 2011

Dig Surg

View full text Add to dashboard Cite

show abstract

“…However, 5-year survival rates vary from 25 to 40% in recently published series. Many clinicopathological factors have been shown to have a positive impact on long-term outcome, including negative histologic margin status [10,22,23], concomitant hepatic resection [4,17,24], lack of nodal involvement [25,26], lower AJCC T stage [27], well-differentiated tumor grade [28], papillary tumor morphology [29], and lack of perineural invasion [12,30]. Prognostic factors on univariate analysis in this study were the presence of residual tumor after resection, histological differentiation, vascular invasion, T stage and lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Surgical Outcome and Prognostic Factors for Hilar Cholangiocarcinoma: A Chinese Experience

Qin

Cui

et al. 2011

Dig Surg

View full text Add to dashboard Cite

Purposes: Hilar cholangiocarcinoma (HC) is the most common location for bile duct cancer. It represents a significant technical challenge for surgical operation due to the close proximity to major vascular structures and to the liver and arborization of the right and left biliary tree. The objective of this study was to assess the therapeutic strategies and prognostic factors that could influence the clinical outcome of HC. Methods: From January 1990 to December 2009, a total of 215 HC patients undergoing resection were included in this study. Survival and follow-up were calculated from the date of initial histologic diagnosis to the dates of first recurrence or death and last contact, respectively. Uni- and multivariate analyses were performed to examine factors affecting clinical outcome and recurrence. Results: 215 patients underwent resection: 141 (65.6%) had an R0 resection (negative histologic margins), 46 (21.4%) had an R1 resection (positive histologic margins), 28 (13.0%) had an R2 resection. The 1-, 3- and 5-year cumulative survival rates (%) of the patients were 60.3, 37.2 and 29.7%. The median survival time after R0 resection was 47.1 months, 17.2 months after R1 resection, and 12.1 months after R2 resection. The results from univariate analyses suggest that poor histopathological grade (p = 0.004), lymph node metastasis (p = 0.000), vascular invasion (p = 0.005), neuroinvasion (p = 0.044), R1 resection (p = 0.000) and T2 or T3 stage (p = 0.009) were significant predictors for poor survival rates. By multivariate analysis, only the lymph node metastasis (RR = 2.450, 95% CI 1.677–3.579) and R1 resection (RR = 0.283, 95% CI 0.183–0.437) were significantly associated with poor survival rates. Conclusions: Negative histologic margins were associated with improved outcome after all HC resections. Complete resection remains the only therapy that offers the possibility of long-term survival, and hepatic resection is a critical component of the surgical approach.

show abstract

“…70,71 In contrast, Japanese literature is unanimous in advising and emphasizing the benefit of PBD. [72][73][74] The postoperative mortality rates after major liver resections performed for hilar CCA in Japan are low, currently between 0% and 9%, for which many consider PBD to be an essential element in preoperative management. [73][74][75][76] Most centers agree that, for tumors requiring extensive liver resection, biliary drainage of at least the future remnant liver is necessary to prevent hepatic failure.…”

Section: Pbd For Proximal Obstructionmentioning

confidence: 99%

“…[72][73][74] The postoperative mortality rates after major liver resections performed for hilar CCA in Japan are low, currently between 0% and 9%, for which many consider PBD to be an essential element in preoperative management. [73][74][75][76] Most centers agree that, for tumors requiring extensive liver resection, biliary drainage of at least the future remnant liver is necessary to prevent hepatic failure. 77 With the introduction of preoperative portal embolization, to induce hypertrophy of the future remnant liver, the application of wider resection margins and the development of new endoscopic techniques are other factors that have led to a favorable attitude for a preoperative drainage strategy.…”

Section: Pbd For Proximal Obstructionmentioning

confidence: 99%

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Gaag

Kloek

Castro

et al. 2009

Journal of Gastrointestinal Surgery

157

113

View full text Add to dashboard Cite

Rationale Preoperative biliary drainage (PBD) has been introduced to improve outcome after surgery in patients suffering from obstructive jaundice due to a potentially resectable proximal or distal bile duct/pancreatic head lesion. In experimental models, PBD is almost exclusively associated with beneficial results: improved liver function and nutritional status; reduction of systemic endotoxemia; cytokine release; and, as a result, an improved immune response. Mortality was significantly reduced in these animal models. Human studies show conflicting results. Findings For distal obstruction, currently the "best-evidence" available clearly shows that routine PBD does not yield the appreciated improvement in postoperative morbidity and mortality in patients undergoing resection. Moreover, PBD harbors its own complications. However, most of the available data are outdated or suffer from methodological deficits. Conclusion The highest level of evidence for PBD to be performed in proximal obstruction, as well as over the preferred mode, is lacking but, nevertheless, assimilated in the treatment algorithm for many centers. Logistics and waiting lists, although sometimes inevitable, could be factors that might influence the decision to opt for PBD, as well as an extended diagnostic workup with laparoscopy (on indication) or scheduled preoperative chemotherapy.

show abstract

Untitled

Cited by 51 publications

References 0 publications

Extent of Liver Resection for Hilar Cholangiocarcinoma (Klatskin Tumor): How Much Is Enough?

Extent of Liver Resection for Hilar Cholangiocarcinoma (Klatskin Tumor): How Much Is Enough?

Analysis of the Surgical Outcome and Prognostic Factors for Hilar Cholangiocarcinoma: A Chinese Experience

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Contact Info

Product

Resources

About