Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2023-09-08 DOI:10.1002/ags3.12734
Fumihiro Kawano, Ryuji Yoshioka, Hirofumi Ichida, Yoshihiro Mise, Akio Saiura
{"title":"Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma","authors":"Fumihiro Kawano,&nbsp;Ryuji Yoshioka,&nbsp;Hirofumi Ichida,&nbsp;Yoshihiro Mise,&nbsp;Akio Saiura","doi":"10.1002/ags3.12734","DOIUrl":null,"url":null,"abstract":"<p>Resection is the only potential curative treatment for perihilar cholangiocarcinoma (PHC); however, complete resection is often technically challenging due to the anatomical location. Various innovative approaches and procedures were invented to circumvent this limitation but the rates of postoperative morbidity (20%–78%) and mortality (2%–15%) are still high. In patients diagnosed with resectable PHC, deliberate and coordinated preoperative workup and optimization of the patient and future liver remnant are crucial. Biliary drainage is recommended to relieve obstructive jaundice and optimize the clinical condition before liver resection. Biliary drainage for PHC can be performed either by endoscopic biliary drainage or percutaneous transhepatic biliary drainage. To date there is no consensus about which method is preferred. The volumetric assessment of the future remnant liver volume and optimization mainly using portal vein embolization is the gold standard in the management of the risk to develop post hepatectomy liver failure. The improvement of systemic chemotherapy has contributed to prolong the survival not only in patients with unresectable PHC but also in patients undergoing curative surgery. In this article, we review the literature and discuss the current surgical treatment of PHC.</p>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Gastroenterological Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ags3.12734","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Resection is the only potential curative treatment for perihilar cholangiocarcinoma (PHC); however, complete resection is often technically challenging due to the anatomical location. Various innovative approaches and procedures were invented to circumvent this limitation but the rates of postoperative morbidity (20%–78%) and mortality (2%–15%) are still high. In patients diagnosed with resectable PHC, deliberate and coordinated preoperative workup and optimization of the patient and future liver remnant are crucial. Biliary drainage is recommended to relieve obstructive jaundice and optimize the clinical condition before liver resection. Biliary drainage for PHC can be performed either by endoscopic biliary drainage or percutaneous transhepatic biliary drainage. To date there is no consensus about which method is preferred. The volumetric assessment of the future remnant liver volume and optimization mainly using portal vein embolization is the gold standard in the management of the risk to develop post hepatectomy liver failure. The improvement of systemic chemotherapy has contributed to prolong the survival not only in patients with unresectable PHC but also in patients undergoing curative surgery. In this article, we review the literature and discuss the current surgical treatment of PHC.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
2021/2022年重要更新:肝门周围胆管癌手术策略更新。
切除术是肝门部周围胆管癌(PHC)的唯一潜在治疗方法;然而,由于解剖位置的原因,完全切除通常在技术上具有挑战性。人们发明了各种创新的方法和程序来规避这一限制,但术后发病率(20%-78%)和死亡率(2%-15%)仍然很高。在被诊断为可切除PHC的患者中,仔细和协调的术前检查以及对患者和未来肝残留的优化是至关重要的。建议在肝切除前进行胆道引流以缓解梗阻性黄疸并优化临床条件。PHC的胆道引流可以通过内镜胆道引流或经皮肝穿刺胆道引流进行。到目前为止,对于哪种方法更可取还没有达成共识。主要使用门静脉栓塞对未来残余肝体积进行体积评估和优化是肝切除术后肝衰竭风险管理的金标准。全身化疗的改善不仅有助于延长无法切除的PHC患者的生存期,也有助于提高接受治疗性手术的患者的生存率。在这篇文章中,我们回顾了文献,并讨论了目前PHC的外科治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
期刊最新文献
Issue Information Laparoscopic median arcuate ligament release using an anterior approach for median arcuate ligament syndrome Issue Information Essential updates 2022–2023: Surgical and adjuvant therapies for locally advanced colorectal cancer Phase II study of long-course chemoradiotherapy followed by consolidation chemotherapy as total neoadjuvant therapy in locally advanced rectal cancer in Japan: ENSEMBLE-2
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1