Surgical Treatment of Hilar and Intrahepatic Cholangiocarcinoma

by Guglielmi, Alfredo; Ruzzenente, Andrea; Iacono, Calogero; Marchiori, Luigi (CON); Pachera, Silvia (CON)

• ISBN13: 9788847007284
• ISBN10: 8847007283
• Edition: 1st
• Format: Paperback
• Copyright: 2007-12-01
• Publisher: Springer Verlag

Summary

Cholangiocarcinoma is the second most frequent primary neoplasm of the liver and its incidence is increasing in Western countries. These neoplasms arise from the biliary tract and can be categorized according to their anatomical location as intrahepatic and extrahepatic cholangiocarcinomas. The prognosis of these neoplasms is poor and most patients are not suitable for curative resection at the time of diagnosis ,due to advanced stage of tumor. Complete surgical resection still remains the only effective and potentially curative therapy. Both intrahepatic and hilar cholangiocarcinoma often requires major liver resection to obtain a radical treatment. In recent years the improvements in non- invasive diagnostic imaging modalities, a better understanding of liver anatomy, the improvements of preoperative optimisation of liver function (preoperative biliary drainage, portal vein embolization), the increased safety of liver surgery have gradually improved the outcome. Moreover, aggressive surgical approach could increase curative surgery. Still now the role of adjunvant therapies and liver transplantation are not well clarified. This book contains an up-to-date review of diagnostic and staging tools of cholangiocarcinoma, a guide to optimal selection of therapeutic modalities and a review of long-term outcome of surgery and liver transplantation. Moreover, it provides details of surgical techniques and principles for curative and palliative surgery. This book will appeal to physicians and hepatobiliary surgeons who want to improve their knowledge about surgical management of intrahepatic and hilar cholangiocarcinomas.

Table of Contents

Hilar Cholangiocarcinoma
Reporting Cholangiocarcinoma: Pathological Aspects	p. 3
Definitions	p. 3
Clinical Information	p. 4
Intraoperative Consultation	p. 5
Macroscopic Examination	p. 6
Pathology Findings in Non-Neoplastic Liver	p. 9
Lymph Nodes (Location, Number)	p. 10
Frozen Tissue (Molecular Studies)	p. 10
Microscopic Examination	p. 10
Additional Pathology Findings	p. 12
Immunohistochemistry	p. 13
Diagnosis	p. 17
Ultrasound (Endoscopic, Intraductal, Transabdominal)	p. 17
Computed Tomography	p. 20
Magnetic Resonance Imaging	p. 21
Positron Emission Tomography	p. 23
Direct Cholangiography (ERCP and PTC)	p. 23
Cholangioscopy (Peroral, Percutaneous)	p. 24
Angiography	p. 25
Preoperative Staging	p. 29
Evaluation of the Biliary Involvement (Longitudinal Extent)	p. 30
Evaluation of Radial Extent: Vascular Involvement, Parenchymal Involvement and Hepatic Lobar Atrophy	p. 33
Preoperative Assessment of Tumour Resectability (T)	p. 35
Evaluation of Lymph Node Status (N)	p. 36
Evaluation of Metastases (M)	p. 37
Conclusions	p. 37
The Role of Laparoscopy in Preoperative Staging	p. 43
Technique	p. 43
Results	p. 44
Laparoscopic Ultrasound	p. 45
Conclusions	p. 46
Preoperative Assessment of Liver Function	p. 49
Preoperative Biliary Drainage	p. 57
Drainage: Pros	p. 58
Drainage: Cons	p. 59
Conclusions	p. 62
Preoperative Portal Vein Embolization	p. 67
Physiopathology of PVE	p. 67
Indications	p. 69
Contraindications	p. 69
Technique	p. 69
Results	p. 71
Post-PVE Course and Timing of Resection	p. 72
Conclusions	p. 72
Prognostic Factors	p. 75
Gross Type	p. 75
Microscopic Pattern	p. 76
Biological and Molecular Prognostic Factors	p. 76
T Category	p. 77
N Category	p. 81
M Category	p. 82
Prognostic Significance of TNM UICC/AJCC Classification	p. 82
Staging Systems	p. 87
Bismuth-Corlette Classification	p. 87
TNM Staging System According to UICC/AJCC 6th Edition	p. 88
Comparison between 5th and 6th Edition of TNM UICC/AJCC	p. 91
Staging System According to JSBS	p. 91
Early Cancer	p. 96
Gazzaniga Staging System	p. 96
Memorial Sloan-Kettering Cancer Center Staging	p. 98
Conclusions	p. 99
Surgical Anatomy of the Hepatic Hilus	p. 101
Anatomy of the Bile Duct Branches	p. 102
Anatomy of the Portal Vein Branches	p. 105
Anatomy of the Hepatic Artery Branches	p. 107
Surgical Anatomy of the Caudate Lobe	p. 108
Surgical Treatment	p. 113
General Principles	p. 113
Assessment of Resectability	p. 115
Indication for Surgical Resection	p. 120
Isolated Extrahepatic Bile Duct Resection	p. 121
Independent Caudate Lobectomy (S1)	p. 122
Central Hepatic Resections	p. 123
Extended Right Resections	p. 124
Extended Left Resections	p. 125
Surgical Technique	p. 129
Position of the Patient	p. 129
Incision	p. 129
Intraoperative Exploration	p. 130
Hepatic Pedicle Dissection and Lymphadenectomy	p. 130
Bile Duct Resection Alone	p. 131
Independent Caudate Lobectomy (S1)	p. 132
Right Hepatectomy with Caudate Lobectomy (S4a, S5, S6, S7, S8 + S1)	p. 133
Right Trisectionectomy with Caudate Lobectomy (S4, S5, S6, S7, S8 + S1)	p. 135
Left Hepatectomy with Caudate Lobectomy (S2, S3, S4 + S1)	p. 138
Left Trisectionectomy with Caudate Lobectomy (S2, S3, S4, S5, S8 + S1)	p. 139
Central (Preserving) Hepatectomy	p. 141
Hepatectomy with Portal Resection and Reconstruction	p. 143
Hepatectomy with Arterial Resection and Reconstruction	p. 148
Hepatopancreatoduodenectomy (HPD)	p. 149
Biliary Anastomosis	p. 150
Results of Surgery	p. 153
Morbidity and Mortality	p. 153
Long-term Results	p. 157
Recurrence	p. 159
The Role of Liver Transplantation	p. 163
Indications and Results	p. 163
Combined Transplantation	p. 165
Transplantation with Adjuvant and Neoadjuvant Treatments	p. 166
Conclusions	p. 167
Adjuvant and Neoadjuvant Treatments	p. 169
Chemotherapy	p. 169
Radiotherapy	p. 170
Chemoradiation Therapy	p. 170
Neoadjuvant Therapy	p. 171
Conclusions	p. 172
Palliative Treatments	p. 175
Palliation of Jaundice	p. 175
Chemotherapy, Radiotherapy and Photodynamic Therapy	p. 179
Intrahepatic Cholangiocarcinoma
Diagnosis	p. 187
Ultrasound	p. 187
Computed Tomography	p. 188
Magnetic Resonance Imaging	p. 190
Angiography	p. 192
Prognostic Factors	p. 193
Gross Type	p. 193
T Category	p. 195
N Category	p. 196
Microscopic Pattern	p. 199
Staging Systems	p. 203
TNM Staging System According to UICC/AJCC	p. 203
TNM Classification According to the LCSGJ	p. 206
Conclusions	p. 210
Surgical Treatment	p. 213
Intraoperative Assessment of Resectability	p. 213
Indications for Surgical Resection	p. 214
Type of Surgical Resection	p. 214
Indications for Lymphadenectomy	p. 217
Extrahepatic Metastases	p. 219
Results of Surgery	p. 221
Morbidity and Mortality	p. 221
Long-Term Survival	p. 222
Recurrence	p. 226
The Role of Liver Transplantation	p. 229
Adjuvant and Palliative Treatments	p. 233
Adjuvant Therapy	p. 233
Palliative Therapy	p. 235
Subject Index	p. 239
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