RT Generic
T1 Vascular Resection in Perihilar Cholangiocarcinoma
A1 Serrablo, Alejandro
A1 Serrablo, Leyre
A1 Alikhanov, Ruslan
A1 Tejedor, Luis
K1 perihilar cholangiocarcinoma
K1 vascular invasion in perihilar cholangiocarcinoma
K1 biliary carcinoma
K1 surgery in vascular involvement
K1 Portal-vein resection
K1 Hepatic-artery reconstruction
K1 Hilar cholangiocarcinoma
K1 Surgical-treatment
K1 Bile-duct
K1 Prognostic-factors
K1 Major hepatectomy
K1 Liver resection
K1 Management
K1 Surgery
AB Simple SummaryIn perihilar cholangiocarcinoma with vascular involvement, vascular resection to achieve margin-free status is being performed with increasing frequency despite controversial results. Morbidity, mortality, and overall survival are widely variable throughout the world. Vascular resections can include the portal vein alone, the hepatic artery alone, or combined resections. In some cases of locally advance disease, extended resections, such as hepatopancreatoduodenectomy or liver transplant, may be performed to achieve R0 status or a change to cure. The neoadjuvant treatment could help to achieve it. This article reviews and updates all treatment options in this setting.Among the cholangiocarcinomas, the most common type is perihilar (phCC), accounting for approximately 60% of cases, after which are the distal and then intrahepatic forms. There is no staging system that allows for a comparison of all series and extraction of conclusions that increase the long-term survival rate of this dismal disease. The extension of the resection, which theoretically depends on the type of phCC, is not a closed subject. As surgery is the only known way to achieve a cure, many aggressive approaches have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection, or even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.
PB Mdpi
YR 2021
FD 2021-11-01
LK https://hdl.handle.net/10668/25003
UL https://hdl.handle.net/10668/25003
LA en
DS RISalud
RD Apr 6, 2025