Radical surgery: vascular and pancreatic resection for cholangiocarcinoma.
Recent progress in vascular surgical techniques has made it possible to combine liver and portal vein and/or hepatic artery (HA) or retrohepatic inferior vena cava (IVC) resection and reconstruction in cases of locally advanced cholangiocarcinoma. Reports of the success of this difficult surgery have been published. Aggressive Japanese surgeons have applied hepatopancreatoduodenectomy (HPD) not just in cases of advanced gallbladder cancer, but also in locally advanced cholangiocarcinoma with or without superficial spread. The above extended surgeries were associated with high postoperative morbidity and mortality, but recent progress in perioperative management and surgical techniques has improved the outcome of these types of surgery. Combined portal vein and liver resection provides R0 resection and contributes to longer survival in resected patients with locally advanced cholangiocarcinoma than in unresected patients. Portal vein invasion is a strong prognostic factor of cholangiocarcinoma and the actual number of 5-year survivors is limited. The number of clinical cases of liver resection combined with IVC or HA resection and reconstruction is still limited, and therefore the long-term survival benefit from these procedures has not been clarified. HPD carried high morbidity and mortality rates in the 1990s, but the outcome has been improving and an increasing number of 5-year survivors has been reported. Although the clinical value of the above extended surgeries has not been evaluated prospectively, with the increasing number of retrospective studies it has been concluded that combined liver and portal vein and/or HA or IVC resection or HPD could be indicated for selected patients with locally advanced cholangiocarcinoma.
Nimura
Y
Y
Aichi Cancer Center, Nagoya, Japan. ynimura@aichi-cc.jp
J Am Coll Surg. 2000 Sep;191(3):244-50
10989898
Hepatogastroenterology. 2007 Mar;54(74):346-9
17523271
Ann Surg. 2003 Nov;238(5):720-7
14578735
J Hepatobiliary Pancreat Surg. 1998;5(1):52-61
9683755
Arch Surg. 2003 Jun;138(6):624-30; discussion 630-1
12799333
World J Surg. 1999 Oct;23(10):1038-43; discussion 1043-4
10512944
Ann Surg. 2004 May;239(5):712-9; discussion 719-21
15082976
Arch Surg. 1983 Oct;118(10):1147-51
6615197
World J Surg. 1996 Jan;20(1):77-80
8588418
Hepatogastroenterology. 1991 Apr;38(2):170-5
1649788
Br J Surg. 1991 Jun;78(6):727-31
2070244
J Hepatobiliary Pancreat Surg. 2002;9(2):237-41
12140613
Surg Endosc. 1988;2(4):213-9
3242144
J Hepatobiliary Pancreat Surg. 2004;11(5):362-5
15549439
Arch Surg. 1974 Aug;109(2):148-53
4367748
Surgery. 1998 Feb;123(2):131-6
9481397
Arch Surg. 1988 Aug;123(8):1021-2
2969230
Ann Surg. 1973 Sep;178(3):333-45
4354116
J Hepatobiliary Pancreat Surg. 2007;14(2):136-41
17384903
Br J Surg. 2003 Jun;90(6):694-7
12808616
J Hepatobiliary Pancreat Surg. 2007;14(2):142-8
17384904
Ann Surg. 2005 May;241(5):693-9; discussion 699-702
15849505
Shujutsu. 1966 Nov;20(11):997-1002
5979048
Am Surg. 2006 Jul;72(7):599-604; discussion 604-5
16875081
Surgery. 2007 May;141(5):581-8
17462457
Am Surg. 1997 Nov;63(11):943-7
9358776
Langenbecks Arch Surg. 2006 Jun;391(3):203-8
16525853
Ann Surg. 1999 Dec;230(6):808-18; discussion 819
10615936
Am J Surg. 1997 Sep;174(3):353-4
9324154
J Am Coll Surg. 2003 Feb;196(2):243-9
12595053
J Am Coll Surg. 2004 Apr;198(4):570-6
15051011
Br J Surg. 1994 Jan;81(1):108-10
7906181
Ann Surg. 2006 Jul;244(1):80-8
16794392
Hepatogastroenterology. 2001 Jul-Aug;48(40):994-8
11490856
Surgery. 1986 Mar;99(3):344-9
3952655