Evolution of Surgical Treatment for Perihilar Cholangiocarcinoma

Nagino, Masato; Ebata, Tomoki; Yokoyama, Yukihiro; Igami, Tsuyoshi; Sugawara, Gen; Takahashi, Yu; Nimura, Yuji

doi:10.1097/sla.0b013e3182708b57

Cited by 505 publications

(239 citation statements)

References 74 publications

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“…A recent study on CH for HCC by Jeng et al [40] reported that even with narrow margins (< 5 mm) after CH, there was no negative impact on recurrence and overall survival. Conversely, Nagino et al [64] recently commented in a review of over three decades of their experience in the evolution of surgical treatment for perihilar CCA; they reported that limited resections such a CH for perihilar CCA decreased significantly from almost 30% to less than 3% over almost 4 decades with a corresponding improved survival due to more R0 resections from extended resections. The role of CH for central HCC and perihilar CCA remains to be defined.…”

Section: Discussionmentioning

confidence: 99%

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Lee¹

2014

WJH

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AIM:To study whether central hepatectomy (CH) can achieve similar overall patient survival and disease-free survival rates as conventional major hepatectomies or not. METHODS:A systematic literature search was performed in MEDLINE for articles published from January 1983 to June 2013 to evaluate the evidence for and against CH in the management of central hepatic malignancies and to compare the perioperative variables and outcomes of CH to lobar/extended hemihepatectomy. RESULTS:A total of 895 patients were included from 21 relevant studies. Most of these patients who underwent CH were a sub-cohort of larger liver resection studies. Only 4 studies directly compared Central vs hemi-/extended hepatectomies. The range of operative time for CH was reported to be 115 to 627 min and Pringle's maneuver was used for vascular control in the majority of studies. The mean intraoperative blood loss during CH ranged from 380 to 2450 mL. The reported morbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mortality ranged from 0.0% to 7.1% with an overall mortality of 2.3% following CH. The 1-year overall survival (OS) for patients underwent CH for hepatocellular carcinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION:Based on current literature, CH is a promising option for anatomical parenchymal-preserving procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.

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Section: Discussionmentioning

confidence: 99%

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Lee¹

2014

WJH

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“…Surgical resection with curative intent provides the best chance of cure and long‐term survival in patients with resectable extrahepatic cholangiocarcinoma 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Recent advances in dimensional imaging, perioperative management, including biliary drainage and percutaneous transhepatic portal vein embolization, and surgical technique have resulted in increased rates of complete resection with histopathologically negative margins and improved patient survival in patients with extrahepatic cholangiocarcinoma 3, 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances in dimensional imaging, perioperative management, including biliary drainage and percutaneous transhepatic portal vein embolization, and surgical technique have resulted in increased rates of complete resection with histopathologically negative margins and improved patient survival in patients with extrahepatic cholangiocarcinoma 3, 4, 5, 6. However, cancer‐free resection margins at the bile duct stump are difficult to achieve because of longitudinal extension, which is one of the prominent characteristics of extrahepatic cholangiocarcinoma 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Wakai

Sakata

Katada

et al. 2018

Annals of Gastroent Surgery

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Recent advances in dimensional imaging, surgical technique, and perioperative patient care have resulted in increased rates of complete resection with histopathologically negative margins and improved surgical outcomes in patients with extrahepatic cholangiocarcinoma. However, achieving cancer‐free resection margins at ductal stumps in surgery for this disease remains challenging because of longitudinal extension, which is one of the hallmarks of extrahepatic cholangiocarcinoma. When the ductal resection margins are shown to be positive on examination of frozen sections, discrimination between carcinoma in situ and invasive carcinoma is clinically important because residual carcinoma in situ may lead to late local recurrence whereas residual invasive carcinoma is associated with early local recurrence. Residual invasive carcinoma at the ductal margins should be avoided whenever technically feasible. Residual “carcinoma in situ” at the ductal margins appears to be allowed in resection for the advanced disease because it has less effect on survival than other adverse prognostic factors (pN1 and/ or pM1). However, in surgery for early‐stage (pTis‐2N0M0) extrahepatic cholangiocarcinoma, residual carcinoma in situ at the ductal margins may have an adverse effect on long‐term survival, so should be avoided whenever possible. In this review, we focus on the histopathological term “carcinoma in situ,” the biological behavior of residual carcinoma in situ at ductal resection margins, intraoperative histological examination of the ductal resection margins, outcome of additional resection for positive ductal margins, and adjuvant therapy for patients with positive margins.

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“…In a single‐center, 34‐year review of 574 consecutive patients, Nagino et al 45. published the results of what is the world's largest cohort of patients who have undergone surgical treatment for perihilar cholangiocarcinoma.…”

Section: Biliary Surgerymentioning

confidence: 99%

Gastroenterological surgery in Japan: The past, the present and the future

Colvin

Mizushima

Eguchi

et al. 2017

Annals of Gastroent Surgery

138

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In the last two centuries, there has been remarkable progress in the field of gastroenterological surgery, including the curative resection of cancers, replacement of failed organs through transplantation, increased safety of undergoing major surgeries and decreased operative morbidity through developments in minimal access surgery. Japan has very much been at the forefront of these advances, as is evident from the present review, from advancing the surgical management of gastric cancer to the pioneering work in live‐donor transplantation. This review also highlights many instances where surgical management of the same pathologies has evolved differently between Japan and the West. It is encouraging that many procedures established in Japan are eventually taken up by the West, often after rigorous assessment affirming the quality and applicability of such techniques. In Japan, many of the crucial issues in gastroenterological surgery are increasingly addressed through large multi‐institutional prospective control trials, ensuring that Japanese surgeons continue to contribute to the advances in gastroenterological surgery.

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Evolution of Surgical Treatment for Perihilar Cholangiocarcinoma

Cited by 505 publications

References 74 publications

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Gastroenterological surgery in Japan: The past, the present and the future

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