Radical surgery for hilar cholangiocarcinoma.
In the therapy of hilar cholangiocarcinoma, the most favorable survival rates over the long-term are achieved by a surgical concept involving a no-touch-technique, en-bloc-resection and wide tumor-free margins. Currently, these goals can be best achieved by our strategy to combine extended right hepatic resections and principle portal vein resection. In spite of extending resectability to patients with locally advanced tumors, formally curative resections could be performed in 80% of the patients. The 5-year survival rate in these patients is 61%. Liver transplantation had been abandoned by most centers in the 1980s due to poor overall results. Recently, a neoadjuvant strategy involving radiochemotherapy has been reported to result in excellent survival figures at least in a subset of patients suffering from cholangiocellular carcinoma arising in a primary sclerosing cholangitis (PSC). This protocol has been mainly proposed by the Mayo Clinic group and reached 5-year survival rates of 80% in those patients in whom it had been applicable. A substantial drop out rate from this neoadjuvant regimen due to tumor progression or treatment related complications is still a problem.
Jonas
S
S
Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow Klinikum, Humboldt-University, Augustenburger Platz 1, 13353 Berlin, Germany. sven.jonas@uniklinik-leipzig.de
Benckert
C
C
Thelen
A
A
Lopez-Hänninen
E
E
Rösch
T
T
Neuhaus
P
P
D001650:Bile Duct Neoplasms / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008197:Lymph Node Excision; D011169:Portal Vein / Q000601:surgery*; D016019:Survival Analysis