Proximal Bile Duct Cancer: High Resectability Rate and 5-Year Survival

Launois, B; Terblanche, J.; Lakéhal, M.; Catheline, Jean-Marc; Bardaxoglou, E.; Landen, S; Campion, Jean‐Pierre; Sutherland, Francis; Meunier, Brigitte

doi:10.1097/00000658-199908000-00018

Cited by 141 publications

(90 citation statements)

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“…Currently, the only way to improve outcome is to increase the resectability rate of proximal bile duct cancer. 11 In conclusion, an experienced hepatobiliary surgeon should evaluate each patient with suspicion of biliary tract carcinoma before palliative biliary drainage is initiated. 13 Helical CT and MRCP are the best imaging techniques to delineate the extent of the tumor and rule out liver metastases and enlarged lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of resectability was based on the posterior approach of the hilus, described by Launois et al 11,15 An anterior incision was made in the anterior face of Glisson's capsule, and a large curved clamp was used to place a tape around the confluence of the portal triad. This maneuver allowed the surgeon to avoid dissecting the bile duct within the hilium, thus achieving an en bloc resection of the tumor with the cellulolymphatic tissue, lymph nodes, and glissonian sheath.…”

Section: Methodsmentioning

confidence: 99%

“…10 In experienced hepatobiliary units, notable advances made in the field of liver surgery have significantly improved postoperative mortality and morbidity. [11][12][13][14] The assessment of resectability of hilar cholangiocarcinoma has also been simplified by the description of the posterior approach of the hilus by Launois et al 11,15 To assess the impact of these and other recent advances in the diagnosis and management of hilar chol-angiocarcinoma, we performed a retrospective analysis of patients with this diagnosis treated at our institution over a 10-year period. The goals of this study are to evaluate (1) the best diagnostic imaging technique for staging of hilar cholangiocarcinoma, (2) the usefulness of preoperative biliary drainage, (3) the resectability rate, and (4) the results of palliative treatments and surgical resection in a specialized hepatobiliary unit.…”

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Changing strategies in diagnosis and management of hilar cholangiocarcinoma

Figueras¹,

Lladó²,

Valls³

et al. 2000

Liver Transpl

101

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Hilar cholangiocarcinoma is one of the most difficult tumors to stage and treat. This study aims to evaluate (1) the best diagnostic imaging, (2) the usefulness of preoperative biliary drainage, (3) the resectability rate, and (4) the results of palliative treatments and surgical resection. Seventy-six patients with hilar cholangiocarcinoma with a mean age of 64 ؎ 11 years were treated at our institution from 1989 to 1999. Patients were studied preoperatively using ultrasound, computed tomography (CT), and percutaneous cholangiography or magnetic resonance cholangiography. Forty-eight patients (63%) underwent palliative treatment. Twenty-eight patients underwent surgical curative therapy; 20 resections and 8 orthotopic liver transplantations (OLTs). Percutaneous transhepatic cholangiography was performed in 18 of 28 patients (64%), and magnetic resonance cholangiography in 5 patients; both methods were equally effective in establishing tumoral invasion of the biliary ducts. Five patients did not undergo either diagnostic modality. Excluding the patients who underwent OLT, no significant differences were found in surgical mortality (1 v 2 patients) or postoperative morbidity (100% v 66%) for patients with and without preoperative biliary drainage. The postoperative mortality rate was 11% (3 of 28 patients). The overall resectability rate was 37%. Mean survival in the surgical and palliative groups was 35 and 6 months, respectively (P < .0001). Patients who underwent OLT had a better 5-year survival rate than those treated by tumor resection (36% v 21%; P ‫؍‬ .02). Combined chemotherapy and radiotherapy apparently did not provide a significant survival benefit. Helical CT and magnetic resonance cholangiography are useful techniques to delineate tumor extent and rule out vascular invasion and lymph node or liver metastases. No clear conclusions regarding preoperative drainage can be drawn from this study. A high resectability rate (37%) is feasible with major hepatectomy. (Liver Transpl 2000;6:786-794.)

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Changing strategies in diagnosis and management of hilar cholangiocarcinoma

Figueras¹,

Lladó²,

Valls³

et al. 2000

Liver Transpl

101

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“…2 Surgery provides the only chance for cure with varying resectability rates of 25-91% depending on tumour location. [3][4][5][6] However, obtaining a negative resection margin (RM) is a challenge, 7,8 and microscopic (R1) and macroscopic (R2) residual diseases are observed in 20-40% and 4-64%, respectively. [9][10][11][12][13][14][15] Many studies have revealed that positive RM of EHBD cancer is directly associated with high local recurrence (LR) rate.…”

Section: Introductionmentioning

confidence: 99%

Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Kim

Min

et al. 2017

The British Journal of Radiology

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Objective: To evaluate the benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic bile duct (EHBD) cancer. Methods: From 1997 to 2015, 59 patients with EHBD cancer were the subject of this study; 36 patients not undergoing adjuvant treatment after surgery (observation group) and 23 patients receiving adjuvant RT (RT group) were compared. Microscopic residual disease (R1) was in 9 (25%) patients and 5 (22%) patients, and macroscopic residual disease (R2) was in 2 (6%) patients and 6 (26%) patients in the observation and RT groups, respectively. Adjuvant RT was delivered to the tumour bed and regional lymph nodes up to 50.4 Gy (range, 45-61 Gy). Results: With a median follow-up of 19 months, local recurrence was observed in 10 (28%) patients and 2 (9%) patients in the observation and RT groups, respectively. On univariate analysis, the 5-year local recurrence-free survival (LRFS) rates were 50% in the observation group and 54% in the RT group (p 5 0.401).The 5-year overall survival (OS) rates were 29.3% in the observation group and 26.3% in the RT group (p 5 0.602). On multivariable analysis, however, adjuvant RT significantly improved LRFS [hazard ratio (HR), 0.310; 95% confidence interval (CI), 0.100-0.963; p 5 0.043] and had a trend towards increased OS (HR, 0.491; 95% CI, 0.219-1.102; p 5 0.085). Resection margin (RM) status was also correlated with LRFS (HR for R1 6.134, 95% CI 2. and HR for R2 18.551,; p , 0.001) and OS (HR for R1 1.816, 95% CI 0.853-3.867; and HR for R2 3.564, 95% CI 1.175-10.809; p 5 0.054). Conclusion: RM status was a significant prognosticator of EHBD cancer, and adjuvant RT improved local control rate; thereby, survival rate might be increased. Advances in knowledge: The benefit of adjuvant RT in EHBD cancer was demonstrated via comparison with observation group.

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“…2 The results of resection are also different according to type of the tumor; tumor, node, metastasis stage; and presence of tumor in the resection margins. 3 Surgery can result in cure for some patients, but this is relatively infrequent.…”

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Revisiting liver transplantation for patients with hilar cholangiocarcinoma: The mayo clinic proposal

Bismuth

2000

Liver Transpl

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T wo types of tumor go under the name of cholangiocarcinoma. The first type is intrahepatic or peripheral cholangiocarcinoma, sometimes called cholangiocellular carcinoma. It is a primary tumor of the liver, occurring less frequently than the other type of primary hepatocellular cancer.The second is called bile duct, ductal, or proximal cholangiocarcinoma. When situated high in the extrahepatic biliary tract, the terms hilar cholangiocarcinoma, cholangiocarcinoma at the confluence of the bile duct, or Klatskin tumor are also used, and the position and extent of the tumor has led to a treatmentoriented classification. 1 Outcomes of treatment of the 2 types of tumor are different, and it would have avoided potential confusion to have used the term hilar cholangiocarcinoma at the outset. Clear distinctions of tumor location, type, and grade are essential to the selection of appropriate literature data for assessment of the results.In the report of de Vreede et al on neoadjuvant chemoirradiation and liver transplantation for cholangiocarcinoma, the tumors are essentially hilar carcinomas. They arise in a territory broader than that of Klatskin tumors, lying above the cystic duct in the upper part of the extrahepatic biliary tract and in the ascending parts of the right and left hepatic ducts.The prognosis for hilar cholangiocarcinoma is generally regarded as poor. The only treatment that can prolong survival is surgical, either by resection or liver transplantation.The major challenge in resection is the position of the tumor close to the hilus and the hepatic pedicle. In the past 2 decades, the number of patients who can be offered resection has been increased by extending the resection to include segments 1 and 4 and by performing right or left hepatectomy according to the principal tumor location. Lymph node curage and pancreaticoduodenectomy are also used.The results of resection are variable between series. Approximately 15% of the patients survive 5 years after surgery, although in 1 series a survival rate of 41% was noted. 2 The results of resection are also different according to type of the tumor; tumor, node, metastasis stage; and presence of tumor in the resection margins. 3 Surgery can result in cure for some patients, but this is relatively infrequent.The use of liver transplantation remains controversial. Usually it is advised to resect the tumor when it is resectable, generally the case in types I, II, and III. A type IV tumor, involving both sides of the confluence, is best resected by total hepatectomy and could be considered an indication for liver transplantation. 4 In our own series of patients with Klatskin tumors, 9 patients have undergone liver transplantation: 3 patients are alive and disease free at 3 years posttransplantation, and 4 patients died of recurrence. Septic complications arising from repeated and long-term stenting were the cause of early death in 2 other patients. In many published series of liver transplantation for malignancy, it is difficult to extract the cases of hilar chol...

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Proximal Bile Duct Cancer: High Resectability Rate and 5-Year Survival

Abstract: ObjectiveTo review and update the authors' experience with resectional surgery for proximal bile duct carcinoma (Klatskin tumor) and assess the role of liver resection over the past 25 years.

Cited by 141 publications

References 20 publications

Changing strategies in diagnosis and management of hilar cholangiocarcinoma

Changing strategies in diagnosis and management of hilar cholangiocarcinoma

Role of adjuvant radiotherapy for localized extrahepatic bile duct cancer

Revisiting liver transplantation for patients with hilar cholangiocarcinoma: The mayo clinic proposal

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