Extended Liver Resection for Intrahepatic Cholangiocarcinoma

Jonas, Sven; Thelen, Armin; Benckert, Christoph; Biskup, Wolfgang; Neumann, Ulf; Rudolph, Birgit; Lopez-Häänninen, Enrique; Neuhaus, P.

doi:10.1097/sla.0b013e318195e164

Cited by 119 publications

(18 citation statements)

References 29 publications

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“…Despite an improved trend in the prognosis of patients with BTC subjected to surgical resection [11,12], the 5-year survival rate has remained approximately 25–30% for successful resection cases [13]. Some investigators have used a more aggressive approach to achieve R0 resection, even in patients with regional lymph node involvement [14]. The value of systematic lymphadenectomy has not been adequately proven to date.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Initial Disease Recurrence after Resection of Biliary Tract Cancer

et al. 2012

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Objectives: This study aimed to provide further insights into the indications for adjuvant therapeutic strategies via analysis of the sites of initial recurrence after resection of gallbladder cancer (GBC) and intrahepatic (IHC) and extrahepatic cholangiocarcinoma (EHC). Methods: Patients with biliary tract cancer who underwent potentially curative resection were identified from the database. Sites of initial disease recurrence were categorized as locoregional or distant. Results: Between March 2001 and April 2009, 231 patients underwent curative resection. Initial GBC and IHC recurrence involving a distant site occurred in 70.8 and 86.8% patients, respectively, compared to 56.9% patients with EHC (p = 0.002). The median time to disease recurrence (TTR) was shorter among the GBC and IHC groups compared with that in EHC patients (6.3 and 6.7 vs. 13.1 months, respectively; p = 0.003). Moreover, median times to distant recurrence in GBC and IHC groups were shorter than that in EHC (5.8 and 6.5 vs. 14.1 months, respectively; p = 0.002). Conclusions: After resection, recurrent GBC and IHC are more likely to involve a distant site and are associated with significantly shorter TTR than recurrent EHC. These findings suggest that an adjuvant therapeutic strategy targeting distant disease is likely to have a signiﬁcant impact on the overall management of GBC and IHC.

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Section: Discussionmentioning

confidence: 99%

Patterns of Initial Disease Recurrence after Resection of Biliary Tract Cancer

et al. 2012

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“…[1,2] Based on its anatomical location, ICC constitutes one of the three categories of cholangiocarcinoma (intrahepatic, hilar, and extrahepatic). As a poorly understood variant of cholangiocarcinoma, ICC has been considered to be the least common category among the above 3 from a histological point of view.…”

Section: Introductionmentioning

confidence: 99%

Influence of surgical margins on overall survival after resection of intrahepatic cholangiocarcinoma

Tang

Lü

Li³

et al. 2016

Medicine

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Background:Surgical resection is shown to present the best chance of cure in the treatment of intrahepatic cholangiocarcinoma (ICC). However, the appropriate length of the negative margin remains unclear. The aim of the present meta-analysis was to investigate whether a clear margin of 10 mm or more (≥10 mm) conferred any survival benefit over a margin of less than 10 mm (<10 mm) in patients with resected ICC.Methods:The meta-analysis was conducted in adherence with the PRISMA guidelines. PubMed, Web of Science, EMBASE, and the Cochrane Library were systematically searched to identify eligible studies published in English from the initiation of the databases to February 2016. Overall survival rates were pooled by using the hazard ratio and the corresponding 95% confidence interval (CI). Random-effect models were utilized because of between-study heterogeneity.Results:Six studies (eight cohorts) reporting on 712 patients were analyzed: 269 (37.80%) were in the 10 mm or more negative margin group, and 443 (62.20%) were in the less than 10 mm negative margin group. The pooled hazard ratio for the less than 10 mm group was found to be 1.59 (95% CI: 1.09–2.32) when this group was compared with the 10 mm or more group (reference), with moderate between-study heterogeneity (I2 = 45.30%, P = 0.07). Commensurate results were identified by sensitivity analysis.Conclusion:The result of this meta-analysis suggests a long-term survival (overall survival) advantage for negative margins of 10 mm or more in comparison with negative margins less than 10 mm for patients undergoing surgical resection of ICC.

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“…Studies about the efficacy of liver resection in patients with IHC showed long-term survival rates ranging from 30−60 % at 5 years after resection [15–17]. Even in the presence of a more advanced tumor stage, partial hepatectomy can provide long-term survival in a considerable share of patients and the growing experience in liver surgery facilitates extended hepatectomies and provides a chance of cure in formerly non-resectable liver malignancies [15]. The published results of large series of patients who received liver resection within the last 2 years underlined not only the therapeutic efficacy of this treatment but also its safety.…”

Section: Discussionmentioning

confidence: 99%

Selective hypertrophy of the lobus caudatus as a novel approach enabling extended right hepatectomy in the presence of a non-perfused left lateral liver lobe

Atanasov

Schmelzle

Thelen

et al. 2014

Clin J Gastroenterol

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IntroductionPortal vein embolization (PVE) is a well-established technique to enhance functional hepatic reserves of segments II and III before curative extended right hepatectomy for tumors of the right liver lobe. However, an adequate hepatopetal flow of the left lateral portal vein branches is required for a sufficient PVE-associated hypertrophy.Case reportHere, we report a 65-year old patient suffering from a locally advanced intrahepatic cholangiocarcinoma in the right liver lobe and segment IV. A curative extended right hepatectomy after preoperative PVE of liver segments IV–VIII was initially impossible because of partial thrombosis of the left lateral portal vein branches resulting in an ischemic-type atrophy of segments II and III. However, due to a massive hypertrophy of the caudate lobe following PVE of liver segments IV–VIII, subsequent extended right hepatectomy with intraoperative thrombectomy of segments II and III was made possible.ConclusionsTo our knowledge this is the first case in which an extended right hepatectomy for a liver malignancy, in the presence of atrophic left lateral section, was made possible by a massive PVE-associated hypertrophy of the caudate lobe.

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Extended Liver Resection for Intrahepatic Cholangiocarcinoma

Cited by 119 publications

References 29 publications

Patterns of Initial Disease Recurrence after Resection of Biliary Tract Cancer

Patterns of Initial Disease Recurrence after Resection of Biliary Tract Cancer

Influence of surgical margins on overall survival after resection of intrahepatic cholangiocarcinoma

Selective hypertrophy of the lobus caudatus as a novel approach enabling extended right hepatectomy in the presence of a non-perfused left lateral liver lobe

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