Surgical management, including the role of transplantation, for intrahepatic and peri-hilar cholangiocarcinoma

IF 3.5 2区 医学 Q2 ONCOLOGY Ejso Pub Date : 2025-02-01 DOI:10.1016/j.ejso.2024.108248
Abdullah K. Malik , Brian R. Davidson , Derek M. Manas
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Abstract

Intrahepatic and peri-hilar cholangiocarcinoma are life threatening disease with poor outcomes despite optimal treatment currently available (5-year overall survival following resection 20-35%, and <10% cured at 10-years post resection). The insidious onset makes diagnosis difficult, the majority do not have a resection option and the high recurrence rate post-resection suggests that occult metastatic disease is frequently present. Advances in perioperative management, such as ipsilateral portal vein (and hepatic vein) embolisation methods to increase the future liver remnant volume, genomic profiling, and (neo)adjuvant therapies demonstrate great potential in improving outcomes. However multiple areas of controversy exist. Surgical resection rate and outcomes vary between centres with no global consensus on how ‘resectable’ disease is defined – molecular profiling and genomic analysis could potentially identify patients unlikely to benefit from resection or likely to benefit from targeted therapies. FDG-PET scanning has also improved the ability to detect metastatic disease preoperatively and avoid futile resection. However tumours frequently invade major vasculo-biliary structures, with resection and reconstruction associated with significant morbidity and mortality even in specialist centres. Liver transplantation has been investigated for very selected patients for the last decade and yet the selection algorithm, surgical approach and both value of both neoadjuvant and adjuvant therapies remain to be clarified. In this review, we discuss the contemporary management of intrahepatic and peri-hilar cholangiocarcinoma.
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肝内和肝周胆管癌的手术治疗,包括移植的作用。
肝内胆管癌和肝周胆管癌是威胁生命的疾病,尽管目前有最佳治疗方法,但疗效不佳(切除术后 5 年总生存率为 20%-35%,而肝内胆管癌为 20%-30%)。
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来源期刊
Ejso
Ejso 医学-外科
CiteScore
6.40
自引率
2.60%
发文量
1148
审稿时长
41 days
期刊介绍: JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.
期刊最新文献
Editorial Board Calendar of events Epidemiology of cholangiocarcinoma National consensus on a new resectability classification for perihilar cholangiocarcinoma - A modified Delphi method Surgical management, including the role of transplantation, for intrahepatic and peri-hilar cholangiocarcinoma
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