Surgical and Palliative Management and Outcome in 184 Patients With Hilar Cholangiocarcinoma

Witzigmann, Helmut; Berr, Frieder; Ringel, Ulrike; Caca, Karel; Uhlmann, Dirk; Schoppmeyer, Konrad; Tannapfel, Andrea; Wittekind, Christian; Mössner, Joachim; Hauss, Johann; Wiedmann, Marcus

doi:10.1097/01.sla.0000217639.10331.47

Cited by 257 publications

(106 citation statements)

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“…Our finding is in line with that of Kosuge et al (1999), who found that patients with a positive resection margin (R1) had a 2.88 times higher mortality risk. The finding was also similar to those reported in other studies (Jarnagin et al, 2005;Witzigmann et al, 2006;Yubin et al, 2008;Unno et al, 2010;Murakami et al, 2011).…”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

Survival Rate of Extrahepatic Cholangiocarcinoma Patients after Surgical Treatment in Thailand

Pattanathien¹,

Khuntikeo²,

Promthet³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Section: Discussionsupporting

confidence: 82%

“…The cumulative survival rates are consistent with the findings of previous studies (Neuhaus et al, 1999;Witzigmann et al, 2006;Li et al, 2011;Murakami et al, 2011). However, our findings are rather different from the from the lower survival rates found in some other studies (Bhudhisawasdi, 1997;Shi QF et al, 2007;Khuntikeo et al, 2008).…”

Section: Discussioncontrasting

confidence: 37%

Survival Rate of Extrahepatic Cholangiocarcinoma Patients after Surgical Treatment in Thailand

Pattanathien¹,

Khuntikeo²,

Promthet³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Even in high-volume centres, the resectability rate is about 30% of all patients with HCC, with the operative mortality rate ranging from 0% to 15%. After curative resection, the 1-, 3-and 5-year survival rates range from 50% to 70%, 30% to 40%, and 10% to 40%, respectively ( Figure 1) [14,20,[43][44][45][46][47][48] . The major determinants of resectability include ex- tent of vascular invasion, hepatic lobar atrophy, amount of hepatic parenchyma involved, and extent of spread within the biliary tree.…”

Section: Staging and Resectabilitymentioning

confidence: 99%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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vein embolization and staging laparoscopy should be considered in selected patients. Additional evidence is needed to fully define the role of orthotopic liver transplant. Portal and lymph node involvement worsen the prognosis and long-term survival, and surgery is the only option that can lengthen it. Improvements in adjuvant therapy are essential for improving long-term outcome. Furthermore, the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option, because operated patients have a longer survival rate than those who not undergo surgery. INTRODUCTIONCarcinomas arising from the confluence of the hepatic ducts were first described by Altemeier et al [1] . Klatskin [2] Alejandro Serrablo, Luis Tejedor Outcome of surgical resection in Klatskin tumors TOPIC HIGHLIGHT AbstractCholangiocarcinomas are the second most frequent primary hepatic malignancy, and make up from 5% to 30% of malignant hepatic tumours. Hilar cholangiocarcinoma (HCC) is the most common type, and accounts for approximately 60% to 67% of all cholangiocarcinoma cases. There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease. Neither the extension of resection, according to the sort of HCC, is a closed topic. Some authors defend limited resection (mesohepatectomy with S1, S1 plus S4b-S5, local excision for papillary tumours, etc .) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure. As there is not an ideal adjuvant therapy, R1 resection can be justified to prolong the survival rate. Morbidity and mortality rates changed along the last decade, but variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Conclusion: Surgical resection continues to be the main treatment of HCC. Negative resection margins achieved with major hepatic resections are associated with improved outcome. Preresectional management with biliary drainage, portal José M Ramia, MD, PhD, Series Editor

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“…Although mortality rates associated with partial hepatectomy have decreased markedly in the past decades, postoperative morbidity is considerable and can exceed 50 percent [1][2][3][4] . Undertaking partial hepatectomy for hilar cholangiocarcinoma (HCCA) becomes even more a subject of discussion when histopathology of the resected specimen shows benign disease.…”

Section: Introductionmentioning

confidence: 99%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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AIM:To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰ compared to group Ⅱ. The various imaging modalities showed vascular involvement exclusively in the malignant group (36%, P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

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Surgical and Palliative Management and Outcome in 184 Patients With Hilar Cholangiocarcinoma

Cited by 257 publications

References 50 publications

Survival Rate of Extrahepatic Cholangiocarcinoma Patients after Surgical Treatment in Thailand

Survival Rate of Extrahepatic Cholangiocarcinoma Patients after Surgical Treatment in Thailand

Outcome of surgical resection in Klatskin tumors

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

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