Portal Vein Resection in Management of Hilar Cholangiocarcinoma

Hemming, Alan W.; Mekeel, Kristin L.; Khanna, Ajai; Baquerizo, Angeles; Kim, Robin D.

doi:10.1016/j.jamcollsurg.2010.12.028

Cited by 89 publications

(114 citation statements)

References 33 publications

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“…No differences in morbidity rates were observed in most of the published studies (17)(18)(19)(20)(21)(22)25,(27)(28)(29)46), as it was the case in the present series. Only one study showed significantly increased morbidity rates when a PVR is performed (23).…”

Section: Discussionsupporting

confidence: 63%

“…In most of the previously reported patients, a segmental PVR was necessary, and a primarily end-to-end anastomosis was possible (5,6,11,19,21,22,27,28,43), as it was the case in the present series.…”

Section: Discussionsupporting

confidence: 59%

“…Regarding the early outcomes, some studies associated a PVR with trends towards increased mortality rates (15,24,27,49) while others did not (6,11,(18)(19)(20)(21)(22)(23)25,28), as it was the case in the present series. No differences in morbidity rates were observed in most of the published studies (17)(18)(19)(20)(21)(22)25,(27)(28)(29)46), as it was the case in the present series.…”

Section: Discussionmentioning

confidence: 42%

“…Although challenging, the safety of a portal vein resection (PVR) during curative-intent surgery for PHC has been demonstrated in several studies (6,7,11,(18)(19)(20). However, the impact of a PVR in PHC surgery remains controversial and previous comparative studies reached conflicting results (5,7,11,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), none including patients from Eastern Europe. Furthermore, meta-analyses comparing the outcomes of patients with and without a PVR for PHC did not reach the same conclusions (29)(30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

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Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Dumitraşcu¹,

Stroescu²,

Brasoveanu³

et al. 2017

chr

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Introducere: Siguranţa rezecţiei de venă portă în chirurgia colangiocarcinoamelor perihilare a fost deja dovedită în Asia, America şi Europa de Vest. Totuşi, nu există nici un fel de date referitoare la acest subiect, care să provină din Europa de Est. Scopul studiului este de a evalua comparativ rezultatele postoperatorii imediate şi pe termen lung după rezecţia cholangiocarcinoamelor perihilare, cu şi fără rezecţie de venă portă. Pacienţi şi metode: Datele a 21 de pacienţi rezecaţi pentru colangiocarcinoame perihilare ce au asociat rezecţia venei porte au fost comparate cu datele a 102 pacienţi fără rezecţie de venă portă. Pentru analiza comparativă a datelor din cele două grupuri s-au folosit teste statistice specifice. Rezultate: Rezecţia venei porte a fost realizată la 17% dintre pacienţi. În grupul pacienţilor cu rezecţie asociată de venă portă au fost realizate semnificativ mai multe trisecţionectomii drepte (p = 0.031) şi rezecţii de lob caudat (p = 0.049). Ca urmare, atât timpul operator (p = 0.015) cât şi pierderea de sânge intraoperator (p = 0.002) au fost semnificativ mai mari în acest grup de pacienţi cu rezecţie de venă portă. Nu s-au constatat diferenţe semnificative între cele două grupuri de pacienţi în ceea ce priveşte rata complicaţiilor severe postoperatorii, mortalitatea postoperatorie şi chimioterapia adjuvantă. Totuşi, în grupul pacienţilor cu rezecţie de venă portă, rata insuficenţei hepatice postoperatorii cu impact clinic

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Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 42%

Section: Introductionmentioning

confidence: 99%

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Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Dumitraşcu¹,

Stroescu²,

Brasoveanu³

et al. 2017

chr

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“…In many studies, the prognosis of patients who received combined PVR is poorer than that of patients who undergo surgical resection without PVR. However, the majority of these studies also show the prognosis of patients treated with combined PVR is significantly longer than the prognosis of unresected patients, especially in patients with hilar/upper bile duct carcinoma [71,72,74,116,155,156]. According to these reports, PVR is a safe procedure and may contribute to longer survival for patients with biliary tract cancers invading portal vein, although there is no prospective study for estimating the benefit of PVR.…”

Section: Cq16: What Are Considered As Unresectable Factors In Biliarymentioning

confidence: 99%

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Miyazaki

Yoshitomi

Miyakawa³

et al. 2015

J Hepato Biliary Pancreat

234

165

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Background The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. Methods Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidencebased approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. Results The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. Conclusions This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via

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Clinical value of additional resection of a margin-positive distal bile duct in perihilar cholangiocarcinoma

Otsuka

Yokoyama

Mizuno

et al. 2019

British Journal of Surgery

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Background: Little is known about the effect of additional resection for a frozen-section-positive distal bile duct margin (DM) in perihilar cholangiocarcinoma. Methods: Patients who underwent surgical resection for perihilar cholangiocarcinoma between 2001 and 2015 were analysed retrospectively, focusing on the DM. Results: Of 558 consecutive patients who underwent frozen-section examination for a DM, 74 (13⋅3 per cent) had a frozen-section-positive DM with invasive cancer or carcinoma in situ. Eventually, 53 patients underwent additional resection (bile duct resection in 44 and pancreatoduodenectomy in 9), whereas the remaining 21 patients did not. Ultimately, R0 resection was achieved in 30 of the 53 patients (57 per cent). No patient who underwent additional resection died from surgical complications. The 44 patients with additional bile duct resection had a 5-year overall survival rate of 31 per cent. Overall survival of the nine patients who had pancreatoduodenectomy was better, with a 10-year rate of 67 per cent. Survival of the 21 patients without additional resection was dismal: all died within 5 years. Multivariable analyses identified nodal status and additional resection as independent prognostic factors (lymph node metastasis: hazard ratio (HR) 2⋅26, 95 per cent c.i. 1⋅26 to 4⋅07; bile duct resection versus no additional resection: HR 0⋅32, 0⋅17 to 0⋅60; pancreatoduodenectomy versus no additional resection: HR 0⋅08, 0⋅02 to 0⋅29). Conclusion: Additional resection for frozen-section-positive DM in perihilar cholangiocarcinoma frequently yields R0 margins. It offers a better chance of long-term survival, and thus should be performed in carefully selected patients. Prognostic factors in patients with a frozen-section-positive distal marginPrognostic factors were analysed in the 74 patients with a frozen-section-positive DM ( Table 2). On univariable analysis, microscopic venous invasion, pathological tumour

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Portal Vein Resection in Management of Hilar Cholangiocarcinoma

Cited by 89 publications

References 33 publications

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Clinical value of additional resection of a margin-positive distal bile duct in perihilar cholangiocarcinoma

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Portal Vein Resection in Management of Hilar Cholangiocarcinoma

Cited by 89 publications

References 33 publications

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

Clinical value of additional resection of a margin-positive distal bile duct in perihilar cholangiocarcinoma

Contact Info

Product

Resources

About

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition