Cholangiocarcinoma surgery: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(38 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Cholangiocarcinoma}}
{{Cholangiocarcinoma}}
{{CMG}}
{{CMG}};{{AE}} {{F.K}} {{PSK}}


==Overview==
==Overview==
The mainstay of treatment for cholangiocarcinoma is surgical resection. Surgical resection of [[Tumor|tumors]] with negative margins is the best option for all subtypes of cholangiocarcinoma.


==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.
*[[Surgery|Surgical exploration]] may be needed to obtain a suitable [[biopsy]] and to accurately [[cancer staging|stage]] a patient with cholangiocarcinoma.
*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.
*[[Laparoscopy]] can be used for staging purposes and may avoid the need for a more [[invasive]] surgical procedure, such as [[laparotomy]].<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>
*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.
*Routine [[lymphadenectomy]] at the time of surgical resection has been recommended to increase the chance of survival. Although it can be omitted in patients with [[solitary]], small peripheral cholangiocarcinoma because of the low risk of [[metastasis]].
*In intrahepatic cholangiocarcinomas, resection has usually been indicated in patients with a solitary tumor and with no underlying hepatic disease.
*Surgical resection is not recommended for cholangiocarcinomas in patients with [[primary sclerosing cholangitis]] because the recurrence rate is very high.
*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.
*Resection is a suitable treatment option for extrahepatic tumors, depending on the extent in the biliary tree and hepatic vasculature.
*When such tumors are restricted to one lobe, there is no metastasis, and liver function is preserved, resection is recommended.
*Partial hepatectomy is the only factor associated with better outcome, probably because this option permits negative margins to be achieved.
*Surgical resection is not recommended for cholangiocarcinomas in patients with primary sclerosing cholangitis because the recurrence rate is very high, close to 90%.
*Liver transplantation is usually recommended for patients with perihilar cholangiocarcinoma diagnosed in the early stages, which cannot be removed surgically, and when no metastases are detected and also for patients with tumors developed in livers with reduced function or underlying a biliary inflammation pathology, such as primary sclerosing cholangitis.


===Intrahepatic cholangiocarcinomas===
*In intrahepatic cholangiocarcinomas, resection has usually been reserved among patients with a [[solitary]] tumor and with no underlying hepatic disease.<ref name="pmid21159105">{{cite journal |vauthors=Ellis MC, Cassera MA, Vetto JT, Orloff SL, Hansen PD, Billingsley KG |title=Surgical treatment of intrahepatic cholangiocarcinoma: outcomes and predictive factors |journal=HPB (Oxford) |volume=13 |issue=1 |pages=59–63 |year=2011 |pmid=21159105 |pmc=3019543 |doi=10.1111/j.1477-2574.2010.00242.x |url=}}</ref>


[[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).
===Extrahepatic cholangiocarcinomas===
*[[Resection]] is an appropriate treatment, depending on the extent in the [[biliary tree]] and hepatic [[vasculature]].<ref name="pmid18773053">{{cite journal |vauthors=Kloek JJ, Ten Kate FJ, Busch OR, Gouma DJ, van Gulik TM |title=Surgery for extrahepatic cholangiocarcinoma: predictors of survival |journal=HPB (Oxford) |volume=10 |issue=3 |pages=190–5 |year=2008 |pmid=18773053 |pmc=2504374 |doi=10.1080/13651820801992575 |url=}}</ref>
*[[Resection]] is usually reserved for extrahepatic cholangiocarcinomas which is restricted to one lobe and without [[metastasis]] and abnormal liver function.<ref name="pmid15621994">{{cite journal |vauthors=Jang JY, Kim SW, Park DJ, Ahn YJ, Yoon YS, Choi MG, Suh KS, Lee KU, Park YH |title=Actual long-term outcome of extrahepatic bile duct cancer after surgical resection |journal=Ann. Surg. |volume=241 |issue=1 |pages=77–84 |year=2005 |pmid=15621994 |pmc=1356849 |doi= |url=}}</ref>
*Tumor ablation performed [[percutaneously]] with sonographic guidance using [[radiofrequency]] or microwave energy is usually reserved for nonoperable tumors up to 5 cm in size.


==Liver Transplant==
===Biliary Stent===
Adjuvant therapy followed by [[liver transplantation]] may have a role in treatment of certain unresectable cases.<ref> 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.</ref>
*Biliary stent is usually reserved for patients with non-operable cholangiocarcinoma.<ref name="pmid23767037">{{cite journal |vauthors=Lee TH |title=Technical tips and issues of biliary stenting, focusing on malignant hilar obstruction |journal=Clin Endosc |volume=46 |issue=3 |pages=260–6 |year=2013 |pmid=23767037 |pmc=3678064 |doi=10.5946/ce.2013.46.3.260 |url=}}</ref>
*It is performed percutaneously. 
*Plastic stents require to be changed every 3 months and metal stents could be maintained for longer times.
*Metal stents are preferred rather than plastic [[Stent|stents]] because of rapid biliary decompression and a low complication rate after insertion.
 
===Liver Transplant===
*[[Liver transplantation]] is usually reserved for patients with cholangiocarcioma with either:<ref name="pmid22504095">{{cite journal |vauthors=Darwish Murad S, Kim WR, Harnois DM, Douglas DD, Burton J, Kulik LM, Botha JF, Mezrich JD, Chapman WC, Schwartz JJ, Hong JC, Emond JC, Jeon H, Rosen CB, Gores GJ, Heimbach JK |title=Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers |journal=Gastroenterology |volume=143 |issue=1 |pages=88–98.e3; quiz e14 |year=2012 |pmid=22504095 |pmc=3846443 |doi=10.1053/j.gastro.2012.04.008 |url=}}</ref><ref name="pmid23533548">{{cite journal |vauthors=Pascher A, Nebrig M, Neuhaus P |title=Irreversible liver failure: treatment by transplantation: part 3 of a series on liver cirrhosis |journal=Dtsch Arztebl Int |volume=110 |issue=10 |pages=167–73 |year=2013 |pmid=23533548 |pmc=3607086 |doi=10.3238/arztebl.2013.0167 |url=}}</ref>
**Perihilar cholangiocarcinoma in the early stages, which cannot be removed surgically
**No detected [[Metastases|metastase]]
**Tumors developed in liver with reduced function or underlying a biliary inflammation pathology, such as [[primary sclerosing cholangitis]].


==References==
==References==
Line 35: Line 44:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Surgery]]

Latest revision as of 17:06, 13 February 2018

Cholangiocarcinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cholangiocarcinoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cholangiocarcinoma surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cholangiocarcinoma surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cholangiocarcinoma surgery

CDC on Cholangiocarcinoma surgery

Cholangiocarcinoma surgery in the news

Blogs on Cholangiocarcinoma surgery

Directions to Hospitals Treating Cholangiocarcinoma

Risk calculators and risk factors for Cholangiocarcinoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Farima Kahe M.D. [2] Suveenkrishna Pothuru, M.B,B.S. [3]

Overview

The mainstay of treatment for cholangiocarcinoma is surgical resection. Surgical resection of tumors with negative margins is the best option for all subtypes of cholangiocarcinoma.

Surgery

  • Surgical exploration may be needed 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.[1][2]
  • Routine lymphadenectomy at the time of surgical resection has been recommended to increase the chance of survival. Although it can be omitted in patients with solitary, small peripheral cholangiocarcinoma because of the low risk of metastasis.
  • Surgical resection is not recommended for cholangiocarcinomas in patients with primary sclerosing cholangitis because the recurrence rate is very high.

Intrahepatic cholangiocarcinomas

  • In intrahepatic cholangiocarcinomas, resection has usually been reserved among patients with a solitary tumor and with no underlying hepatic disease.[3]

Extrahepatic cholangiocarcinomas

  • Resection is an appropriate treatment, depending on the extent in the biliary tree and hepatic vasculature.[4]
  • Resection is usually reserved for extrahepatic cholangiocarcinomas which is restricted to one lobe and without metastasis and abnormal liver function.[5]
  • Tumor ablation performed percutaneously with sonographic guidance using radiofrequency or microwave energy is usually reserved for nonoperable tumors up to 5 cm in size.

Biliary Stent

  • Biliary stent is usually reserved for patients with non-operable cholangiocarcinoma.[6]
  • It is performed percutaneously.
  • Plastic stents require to be changed every 3 months and metal stents could be maintained for longer times.
  • Metal stents are preferred rather than plastic stents because of rapid biliary decompression and a low complication rate after insertion.

Liver Transplant

  • Liver transplantation is usually reserved for patients with cholangiocarcioma with either:[7][8]
    • Perihilar cholangiocarcinoma in the early stages, which cannot be removed surgically
    • No detected metastase
    • Tumors developed in liver with reduced function or underlying a biliary inflammation pathology, such as primary sclerosing cholangitis.

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ Ellis MC, Cassera MA, Vetto JT, Orloff SL, Hansen PD, Billingsley KG (2011). "Surgical treatment of intrahepatic cholangiocarcinoma: outcomes and predictive factors". HPB (Oxford). 13 (1): 59–63. doi:10.1111/j.1477-2574.2010.00242.x. PMC 3019543. PMID 21159105.
  4. ↑ Kloek JJ, Ten Kate FJ, Busch OR, Gouma DJ, van Gulik TM (2008). "Surgery for extrahepatic cholangiocarcinoma: predictors of survival". HPB (Oxford). 10 (3): 190–5. doi:10.1080/13651820801992575. PMC 2504374. PMID 18773053.
  5. ↑ Jang JY, Kim SW, Park DJ, Ahn YJ, Yoon YS, Choi MG, Suh KS, Lee KU, Park YH (2005). "Actual long-term outcome of extrahepatic bile duct cancer after surgical resection". Ann. Surg. 241 (1): 77–84. PMC 1356849. PMID 15621994.
  6. ↑ Lee TH (2013). "Technical tips and issues of biliary stenting, focusing on malignant hilar obstruction". Clin Endosc. 46 (3): 260–6. doi:10.5946/ce.2013.46.3.260. PMC 3678064. PMID 23767037.
  7. ↑ Darwish Murad S, Kim WR, Harnois DM, Douglas DD, Burton J, Kulik LM, Botha JF, Mezrich JD, Chapman WC, Schwartz JJ, Hong JC, Emond JC, Jeon H, Rosen CB, Gores GJ, Heimbach JK (2012). "Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers". Gastroenterology. 143 (1): 88–98.e3, quiz e14. doi:10.1053/j.gastro.2012.04.008. PMC 3846443. PMID 22504095.
  8. ↑ Pascher A, Nebrig M, Neuhaus P (2013). "Irreversible liver failure: treatment by transplantation: part 3 of a series on liver cirrhosis". Dtsch Arztebl Int. 110 (10): 167–73. doi:10.3238/arztebl.2013.0167. PMC 3607086. PMID 23533548.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Cholangiocarcinoma_surgery&oldid=1443975"