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Hilar cholangiocarcinoma perioperative management

Yinzhe Xu, Hongguang Wang, Webin Ji, Maosheng Tang, Hao Li, Jianjun Leng, Xuan Meng, Jiahong Dong
BACKGROUND: Radical resection for hilar cholangiocarcinoma (HCa) is one of the most challenging abdominal procedures. Robotic-assisted approach is gaining popularity in hepatobiliary surgery but scarcely tried in the management of HCa. We herein report our initial experience of robotic radical resection for HCa. METHODS: Between May 2009 and October 2012, 10 patients underwent fully robotic-assisted radical resection for HCa in a single institute. The perioperative and long-term outcomes were analyzed and compared with a contemporaneous 32 patients undergoing traditional open surgery...
July 2016: Surgical Endoscopy
Katherine E Poruk, Timothy M Pawlik, Matthew J Weiss
BACKGROUND: Cholangiocarcinoma is the most common primary tumor of the biliary tract although it accounts for only 2 % of all human malignancies. We herein review hilar cholangiocarcinoma including its risk factors, the main classification systems for tumors, current surgical management of the disease, and the role chemotherapy and liver transplantation may play in selected patients. METHODS: We performed a comprehensive literature search using PubMed, Medline, and the Cochrane library for the period 1980-2015 using the following MeSH terms: "hilar cholangiocarcinoma", "biliary cancer", and "cholangiocarcinoma"...
October 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Yongjia Yan, Ning Lu, Weijun Tian, Tong Liu
BACKGROUND AND OBJECTIVES: The rapid development of the Chinese economy has enabled advances to be made in the surgical treatment of Klatskin tumors. We retrospectively reviewed the surgical outcomes of hilar cholangiocarcinoma at a single Chinese center, focusing on the surgical procedures, radicality of the operative procedure (R0, R1 or R2), survival rates, and independent prognostic factors. This objective of the analysis was to evaluate improvements in perioperative and long-term outcomes of surgical resection of Klatskin tumors...
November 2014: Tumori
S Heinrich, H Lang
BACKGROUND: Chronic liver parenchymal diseases as well as cholestasis are established risk factors for liver failure after partial hepatectomy. As hepatocellular (HCC) and cholangiocellular (CCC) carcinoma often require extended resection due to the often considerable size of tumors - in an often priorly damaged liver - surgery for these entities is usually demanding. Due to the lack of potent systemic treatment for primary liver tumors, surgery remains the only potentially curative treatment option for CCC and most HCC; therefore, perioperative risk factors for liver failure should be reduced as far as possible...
February 2015: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Ryota Higuchi, Takehiro Ota, Takehisa Yazawa, Hideki Kajiyama, Tatsuo Araida, Toru Furukawa, Tatsuya Yoshikawa, Ken Takasaki, Masakazu Yamamoto
PURPOSE: This study aimed to examine the changes in procedures for hilar cholangiocarcinoma (HC) surgery and patient survival following HC surgery over a 40-year period. METHODS: Between 1974 and 2014, 239 consecutive patients underwent surgery for HC. The changes in perioperative therapy and short- and long-term surgical outcomes were evaluated. RESULTS: The rates of major hepatectomy (in particular, right hepatectomy) and R0 resection significantly increased...
January 2016: Surgery Today
Takahiro Tsuchikawa, Satoshi Hirano, Keisuke Okamura, Joe Matsumoto, Eiji Tamoto, Soichi Murakami, Toru Nakamura, Yuma Ebihara, Yo Kurashima, Toshiaki Shichinohe
With the improvement of perioperative management and surgical techniques as well as the accumulation of knowledge on the oncobiological behavior of bile duct carcinoma, the long-term prognosis of hilar cholangiocarcinoma has been improving. In this article, the authors review the recent developments in surgical strategies for hilar cholangiocarcinoma, focusing on diagnosis for characteristic disease extension, perioperative management to reduce postoperative morbidity and mortality, surgical techniques for extended curative resection and postoperative adjuvant therapy...
March 2015: Expert Review of Gastroenterology & Hepatology
Takahiro Tsuchikawa, Satoshi Hirano, Eiichi Tanaka, Kentaro Kato, Joe Matsumoto, Takehiro Noji, Toshiaki Shichinohe
BACKGROUND/AIMS: There have been few papers on how to treat hepatobiliary malignancies after ERCP-related pancreatitis focusing on the timing of the operation and postoperative complications. The aim of this study was to clarify the relationship among the time after the pancreatitis, the complexity of the operation, and the characteristic postoperative complications. METHODOLOGY: The clinicopathological characteristics of five patients with hepatobiliary malignancies who had a prior history of ERCP-related pancreatitis were analyzed...
September 2013: Hepato-gastroenterology
Jian-dong Wang, Jun Shen, Xue-ping Zhou, Peng-yuan Zhuang, Di Zhou, Yong Yang, Ying-bin Liu, Zhi-wei Quan
OBJECTIVE: To investigate the comprehensive measures for improving radical resection rate and safety of Bismuth-Corlette type III hilar cholangiocarcinoma. METHODS: The clinical data of 15 patients with Bismuth-Corlette type III hilar cholangiocarcinoma who performed radical resection from June 2009 to December 2011 was analyzed retrospectively. There were 11 male and 4 female patients, aged from 45 to 74 years (mean 59 years). The preoperative evaluation were conducted by using magnetic resonance cholangiopancreatography (MRCP), dual source spiral CT combined with IQQA-Liver CT Imaging Analysis System providing three-dimensional reconstruction of tumor, bile duct, hepatic artery and portal vein, which could help to chose the appropriate treatment modality...
July 2013: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Francesca Ratti, Federica Cipriani, Fabio Ferla, Marco Catena, Michele Paganelli, Luca A M Aldrighetti
INTRODUCTION: The diagnosis and treatment of hilar tumors requires a multidisciplinary approach based on the synergy of radiologists, surgeons, oncologists, and gastroenterologists. Klatskin tumor is a relatively rare disease with a poor prognosis. Currently, the only possible treatment is represented by the removal of the tumor associated with radical surgery, even though its results are still jeopardized by significant morbidity and mortality. A proper preoperative optimization of the patient, including staging laparoscopy, biliary drainage, and portal vein embolization, may improve short-term outcome...
June 2013: World Journal of Surgery
Jin-Bo Gao, Li-Shan Bai, Zhi-Jian Hu, Jun-Wei Wu, Xin-Qun Chai
AIM: To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures. METHODS: Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed. Kasai portoenterostomy with the placement of biliary stents was performed in all patients. Clinical characteristics, postoperative complications, and long-term outcomes were analyzed. All patients were followed up for 2-60 mo postoperatively...
October 7, 2011: World Journal of Gastroenterology: WJG
Alan W Hemming, Kristin Mekeel, Ajai Khanna, Angeles Baquerizo, Robin D Kim
BACKGROUND: Vascular reconstruction along with major liver resection in the setting of liver dysfunction caused by biliary obstruction can be associated with increased risk. The purpose of this report is to assess the role of portal vein resection and reconstruction in the surgical management of hilar cholangiocarcinoma. STUDY DESIGN: Ninety-five patients with hilar cholangiocarcinoma who underwent resection between 1999 and 2010 were reviewed. Liver resections performed along with biliary resection included 84 trisegmentectomies (63 right, 21 left) and 11 lobectomies (8 left, 3 right)...
April 2011: Journal of the American College of Surgeons
Michail Papoulas, Nir Lubezky, Yaacov Goykhman, Isaac Kori, Erwin Santo, Richard Nakache, Joseph Klausner, Menahem Ben-Haim
BACKGROUND: The diagnostic and therapeutic approach to hilar cholangiocarcinoma and thus the prognosis have changed significantly over the last two decades. Nonetheless, hilar cholangiocarcinoma presents a complex surgical challenge. OBJECTIVES: To assess the outcome of the radical approach for the management of types III and IV hilar cholangiocarcinoma. METHODS: We conducted a retrospective single-center study. Preoperative diagnosis was based on ultrasound, computed tomography and selective percutaneous cholangiography without tissue diagnosis...
February 2011: Israel Medical Association Journal: IMAJ
Jean Marc Regimbeau, David Fuks, Yves-Patrice Le Treut, Philippe Bachellier, Jacques Belghiti, Karim Boudjema, Jacques Baulieux, François-René Pruvot, Daniel Cherqui, Olivier Farges
INTRODUCTION: Surgical resection is the only option for long-term survival in patients with hilar cholangiocarcinoma (HC), but it is associated with high morbidity and mortality. The aim of the present study was to prospectively assess the perioperative management and short-term outcomes of surgical treatment of HC in a recent, multi-institutional study with a short inclusion period. METHODS: Between January and December 2008, a register prospectively collected data on patients operated on for HC (exploratory or curative surgery) in eight tertiary centers...
March 2011: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
F Giuliante, F Ardito, M Vellone, G Nuzzo
Hilar cholangiocarcinoma (HC) is a rare tumor which has to be distinguished by intrahepatic cholagiocarcinoma invading hepatic hilum because the former has better prognosis then the latter. Patients with HC are difficult to manage because many challenging issues remain in the treatment of this tumour regarding correct diagnosis and therapeutic strategy. HC is resectable in about 30% of cases, but operative risk is highly influenced by septic complications of preoperative biliary drainage and by the need of major liver resection associated with biliary resection...
April 2010: European Review for Medical and Pharmacological Sciences
Zhi-qiang Huang, Li-ning Xu, Tao Yang, Wen-zhi Zhang, Xiao-qiang Huang, Shou-wang Cai, Ai-qun Zhang, Yu-quan Feng, Ning-xin Zhou, Jia-hong Dong
BACKGROUND: Hepatectomy is a standard hepatic surgical technique. The safety of hepatectomy has been improved in line with improvements in surgical techniques. This study analyzed the operative and perioperative factors associated with hepatectomy. METHODS: A total of 2008 patients who underwent consecutive hepatectomies between January 1986 and December 2005 were investigated retrospectively. Diagnoses were made based on pathological findings. RESULTS: Malignant and benign liver diseases accounted for 58...
October 5, 2009: Chinese Medical Journal
Shou-wang Cai, Wei-dong Duan, Zhe Liu, Xiang-qian Zhao, Wen-zhi Zhang, Jing Wang, Xiao-qiang Huang, Jia-hong Dong, Zhi-qiang Huang
OBJECTIVE: To summarize the methods, safety and efficiency of surgical resection for hilar cholangiocarcinoma. METHODS: The clinical and follow-up data of 48 patients with hilar cholangiocarcinoma underwent surgical resection from January 2003 to December 2007 were analyzed retrospectively. There were 26 male and 22 female, aged from 38 to 72 years old with a mean of 63.6 years old. RESULTS: Perioperative management including percutaneous transhepatic biliary drainage applied in 19 cases and portal vein embolization applied in 2 cases...
August 1, 2009: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Masaru Miyazaki, Fumio Kimura, Hiroaki Shimizu, Hiroyuki Yoshidome, Masayuki Otuka, Atushi Kato, Hideyuki Yoshitomi, Katsunori Furukawa, Dan Takeuchi, Tsukasa Takayashiki, Kousuke Suda, Shigetugu Takano
Many authors at high-volume centers all over the world have reported improved outcomes of hilar cholangiocarcinoma by several aggressive surgical approaches such as extended hepatic resection, combined vascular resection, and hepatopancreaticoduodenectomy in recent years. There has been great progress in the surgical treatment of hilar cholangiocarcinoma with these previous efforts by aggressive hepatobiliary surgeons. In particular, surgical techniques, diagnostic modalities, and perioperative management have been remarkably improved as compared with before...
July 2010: Journal of Hepato-biliary-pancreatic Sciences
Kevin Tri Nguyen, Jennifer Steel, Tsafrir Vanounou, Allan Tsung, J Wallis Marsh, David A Geller, T Clark Gamblin
BACKGROUND: Cholangiocarcinoma (CC) frequently presents at an advanced stage and the majority of patients are unresectable at diagnosis. We sought to examine our recent experience with surgical resection for hilar and peripheral CC. METHODS: A review of all CC patients who presented to our multidisciplinary liver cancer center for evaluation of their CC between January 2000 and August 2008 was performed. Demographics, therapeutic management, pathologic characteristics, and overall survival were analyzed...
December 2009: Annals of Surgical Oncology
Zhi-qiang Huang, Li-ning Xu, Tao Yang, Wen-zhi Zhang, Xiao-qiang Huang, Rong Liu, Shou-wang Cai, Ai-qun Zhang, Yu-quan Feng, Ning-xin Zhou, Jia-hong Dong
OBJECTIVE: To analyze operative and perioperative factors associated with hepatectomy. METHODS: 2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation. Diagnoses were made on basis of pathological results. RESULTS: Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively...
September 1, 2008: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Masato Nagino
Hilar cholangiocarcinoma is very difficult to treat, and resection of the tumor remains challenging. In Japan, accurate diagnosis of tumor extension and meticulous evaluation of liver function are routinely performed before surgery for hilar cholangiocarcinoma. Biliary drainage is a prerequisite part of presurgical management, and portal vein embolization is performed in many high-volume centers. In contrast, in Europe preoperative diagnosis of tumor extension is "rough" with fewer diagnostic modalities employed compared with Japan...
November 2008: Nihon Geka Gakkai Zasshi
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