Cholangiocarcinoma surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
The options for the treatment of cholangiocarcinoma are limited and associated with high rates of perioperative mortality, recurrence, and short survival times. Surgical resection of tumors with negative margins is the best option for all subtypes of cholangiocarcinoma although it is only achieved in less than 50% of cases. | |||
*Curative resection, or resection of tumor-free surgical margins (R0), remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection. | |||
*Routine lymphadenectomy at the time of surgical resection has been proposed in order to increase the chance of survival. However, it can be omitted in patients with solitary, small peripheral cholangiocarcinoma because the probability of lymph node metastasis is very low. | |||
*In intrahepatic cholangiocarcinomas, resection has usually been indicated in patients with a solitary tumor and with no underlying hepatic disease. | |||
*A recent study has concluded that major hepatectomy for intrahepatic cholangiocarcinoma is also indicated in selected cirrhotic patients because the overall morbidity, hospital mortality rates, and the appearance of liver failure and other complications (superficial wound infection, abscesses, sepsis, pancreatic leakage, delayed gastric emptying, or biliary leakage) are similar in patients with and without cirrhosis. | |||
* | |||
[[Surgery|Surgical exploration]] may be necessary to obtain a suitable [[biopsy]] and to accurately [[cancer staging|stage]] a patient with cholangiocarcinoma. [[Laparoscopy]] can be used for staging purposes and may avoid the need for a more invasive surgical procedure, such as [[laparotomy]], in some patients.<ref>{{cite journal |author=Weber S, DeMatteo R, Fong Y, Blumgart L, Jarnagin W |title=Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients |journal=Ann Surg |volume=235 |issue=3 |pages=392-9 |year=2002 |id=PMID 11882761}}</ref><ref>{{cite journal |author=Callery M, Strasberg S, Doherty G, Soper N, Norton J |title=Staging laparoscopy with laparoscopic ultrasonography: optimizing resectability in hepatobiliary and pancreatic malignancy |journal=J Am Coll Surg |volume=185 |issue=1 |pages=33-9 |year=1997 |id=PMID 9208958}}</ref> Surgery is also the only curative option for cholangiocarcinoma, although it is limited to patients with early-stage disease (see below). | [[Surgery|Surgical exploration]] may be necessary to obtain a suitable [[biopsy]] and to accurately [[cancer staging|stage]] a patient with cholangiocarcinoma. [[Laparoscopy]] can be used for staging purposes and may avoid the need for a more invasive surgical procedure, such as [[laparotomy]], in some patients.<ref>{{cite journal |author=Weber S, DeMatteo R, Fong Y, Blumgart L, Jarnagin W |title=Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients |journal=Ann Surg |volume=235 |issue=3 |pages=392-9 |year=2002 |id=PMID 11882761}}</ref><ref>{{cite journal |author=Callery M, Strasberg S, Doherty G, Soper N, Norton J |title=Staging laparoscopy with laparoscopic ultrasonography: optimizing resectability in hepatobiliary and pancreatic malignancy |journal=J Am Coll Surg |volume=185 |issue=1 |pages=33-9 |year=1997 |id=PMID 9208958}}</ref> Surgery is also the only curative option for cholangiocarcinoma, although it is limited to patients with early-stage disease (see below). | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
The options for the treatment of cholangiocarcinoma are limited and associated with high rates of perioperative mortality, recurrence, and short survival times. Surgical resection of tumors with negative margins is the best option for all subtypes of cholangiocarcinoma although it is only achieved in less than 50% of cases.
- Curative resection, or resection of tumor-free surgical margins (R0), remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.
- Routine lymphadenectomy at the time of surgical resection has been proposed in order to increase the chance of survival. However, it can be omitted in patients with solitary, small peripheral cholangiocarcinoma because the probability of lymph node metastasis is very low.
- In intrahepatic cholangiocarcinomas, resection has usually been indicated in patients with a solitary tumor and with no underlying hepatic disease.
- A recent study has concluded that major hepatectomy for intrahepatic cholangiocarcinoma is also indicated in selected cirrhotic patients because the overall morbidity, hospital mortality rates, and the appearance of liver failure and other complications (superficial wound infection, abscesses, sepsis, pancreatic leakage, delayed gastric emptying, or biliary leakage) are similar in patients with and without cirrhosis.
Surgical exploration may be necessary to obtain a suitable biopsy and to accurately stage a patient with cholangiocarcinoma. Laparoscopy can be used for staging purposes and may avoid the need for a more invasive surgical procedure, such as laparotomy, in some patients.[1][2] Surgery is also the only curative option for cholangiocarcinoma, although it is limited to patients with early-stage disease (see below).
Liver Transplant
Adjuvant therapy followed by liver transplantation may have a role in treatment of certain unresectable cases.[3]
References
- ↑ Weber S, DeMatteo R, Fong Y, Blumgart L, Jarnagin W (2002). "Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients". Ann Surg. 235 (3): 392–9. PMID 11882761.
- ↑ Callery M, Strasberg S, Doherty G, Soper N, Norton J (1997). "Staging laparoscopy with laparoscopic ultrasonography: optimizing resectability in hepatobiliary and pancreatic malignancy". J Am Coll Surg. 185 (1): 33–9. PMID 9208958.
- ↑ Heimbach JK, Gores GJ, Haddock MG, et al, Predictors of disease recurrence following neoadjuvant chemoradiotherapy and liver transplantation for unresectable perihilar cholangiocarcinoma, Transplantation. 2006 Dec 27;82(12):1703-7.