Surgical therapy and survival prospects in hilar cholangiocarcinoma Journal Article
| Authors: | D'Angelica, M.; Jarnagin, W. R.; Blumgart, L. H. |
| Article Title: | Surgical therapy and survival prospects in hilar cholangiocarcinoma |
| Abstract: | Background: In the past, surgical cure of a cholangiocarcinoma arising at the biliary confluence - the preferential site for this uncommon cancer - has been hampered by the inherent risks of resection and the difficulty in achieving negative histological margins. Most patients present with jaundice, and bacterbilia is present in up to 30% even in the absence of a biliary stent. Modern surgical techniques that include resection of liver tissue may improve the rate of 'curative' resection and therefore of long-term survival. Discussion: Increasing reliance is now placed on duplex ultrasonography and magnetic resonance cholangiography. Lobar atrophy is an important finding that indicates obstruction of the portal vein and/or bile duct to that portion of the liver, so that resection (if feasible) must include a partial hepatectomy. A new staging system based on all the tumor-related factors that determine resectability has proved useful in practice. Staging lapacoscopes will also avoid unnecessary operation in one third of those with locally advanced (but potentially resectable) tumors, The current shortage of donors plus limited survival means that orthotopic liver transplant is only justifiable on a trial basis. By contrast, resection including hepatectomy can now be achieved with acceptable risk and a median survival of 46 months in those with negative margins. For central or left-sided tumors, the caudate lobe should be resected en bloc. An overall 5-year survival rate of about 20% can be anticipated after surgical resection of hilar cholangiocarcinoma. |
| Keywords: | cancer chemotherapy; cancer survival; treatment outcome; surgical technique; survival rate; review; cancer localization; advanced cancer; liver transplantation; cancer radiotherapy; cancer staging; staging; antineoplastic agent; clinical practice; differential diagnosis; doppler echography; survival time; surgical risk; long term care; jaundice; liver resection; surgical mortality; hepatectomy; reliability; bile duct carcinoma; biliary tract surgery; surgical resection; bile duct obstruction; liver hilus; hilar cholangiocarcinoma; bile duct tumor; organ donor; liver atrophy; magnetic resonance cholangiopancreatography; laparoscope; portal vein obstruction; human |
| Journal Title: | HPB |
| Volume: | 5 |
| Issue: | 1 |
| ISSN: | 1365-182X |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2003-01-01 |
| Start Page: | 6 |
| End Page: | 10 |
| Language: | English |
| DOI: | 10.1080/1365182030000208 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 25 September 2014 -- Source: Scopus |
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777D'Angelica
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