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Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

World Journal of Gastroenterology 2020年第25期26卷 3542-3561页

作者： daniele dondossola Michele Ghidini Francesco Grossi Giorgio Rossi Diego Foschi General and Liver Transplant Surgery Unit Fondazione IRCCS Ca'GrandaOspedale Maggiore PoliclinicoMilan 20122Italy Department of Pathophysiology and Transplantation Universitàdegli Studi of MilanMilan 20122Italy Medical Oncology Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore PoliclinicoMilan 20122Italy Department of Biomedical and Clinical Sciences"Luigi Sacco" L.Sacco HospitalUniversitàdegli Studi of MilanMilan 20157Italy

Cholangiocarcinoma(CCC)is the most aggressive malignant tumor of the biliary *** CCC(pCCC)is the most common CCC and is burdened by a complicated diagnostic iter and its anatomical location makes surgical approach burden by poor *** its clinical presentation,a multimodal diagnostic approach should be carried on by a tertiary specialized center to avoid *** staging must consider the extent of liver resection to avoid post-surgical hepatic *** staging iter,magnetic resonance can obtain satisfactory cholangiographic images,while invasive techniques should be used if bile duct samples are ***,to improve diagnostic potential,bile duct drainage is not necessary in jaundice,while it is indicated in refractory cholangitis or when liver hypertrophy is *** resecability criteria are identified,the extent of liver resection is secondary to the longitudinal spread of *** in the past type IV pCCC was not considered resectable,some authors reported good results after their ***,in selected unresectable cases,liver transplantation could be a valuable *** chemotherapy is the standard of care for resected patients,while neoadjuvant approach has growing *** curative resection is not achieved,radiotherapy can be added to *** multistep curative iter must be carried on in specialized ***,the aim of this review is to highlight the main steps and pitfalls of the diagnostic and therapeutic approach to pCCC with a peculiar attention to type IV pCCC.

关键词： Perihilar cholangiocarncioma Liver resection Biliary drainage Neo-adjuvant therapy Type IV cholangiocarcinoma Klatskin tumor

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