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Neoadjuvant chemoradiotherapy before resection of perihilar cholangiocarcinoma: A systematic review

Hepatobiliary & Pancreatic Diseases International 2020年第2期19卷 103-108页

作者： Minas Baltatzis Santhalingam Jegatheeswaran Ajith K.Siriwardena Regional Hepato-Pancreato-Biliary Surgery Unit Manchester Royal InfirmaryOxford RoadManchester M139WLUK Faculty of Biology Medicine and HealthUniversity of ManchesterManchester M139WLUK

Background: Treatment with neoadjuvant chemoradiotherapy followed by liver transplantation yields promising results in perihilar cholangiocarcinoma (PH-CCA). This study reviews the literature to assess whether there is evidence to justify modern phase Ⅱ studies of neoadjuvant chemoradiotherapy prior to resection of PH-CCA.Data sources: A systematic review of the literature for reports of patients undergoing resection of PH- CCA after neoadjuvant chemoradiotherapy was performed using MEDLINE and EMBASE databases for the period between 1990 and 2019. The keywords and MeSH headings "hilar cholangiocarcinoma", "Klatskin", "chemoradiotherapy" and "chemotherapy" were used. Data were extracted on demographic profile, dis- ease staging, chemoradiotherapy protocols, complications and outcome. Risks of bias were assessed using Cochrane methodology. Results: There were seven reports on this topic, with median recruitment period of 14 (range 4–31) years. The total number of patients in these studies was 87. Interval from completion of neoadjuvant treatment to surgery varied from 3 days to 6 months. Resection was by hepatectomy with three studies reporting an R0 rate of 100%, 24% and 63%, respectively. Three studies reported histopathological evidence of prior treatment response. There were two treatment related deaths at 90 days. Median survival was 19 (95% CI: 9.9–28) months and 5-year survival 20%. Conclusions: There are potential benefits of treatment on both R0 rate and complete response in resected specimens. Scientific equipoise exists in relation to neoadjuvant chemoradiotherapy for PH-CCA.

关键词： perihilar cholangiocarcinoma Neoadjuvant Chemotherapy Radiotherapy Surgery

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Cystic micropapillary neoplasm of peribiliary glands withconcomitant perihilar cholangiocarcinoma

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World Journal of Gastroenterology 2016年第7期22卷 2391-2397页

作者： Tsuneyuki Uchida Yusuke Yamamoto Takaaki Ito Yukiyasu Okamura Teiichi Sugiura Katsuhiko Uesaka Yasuni Nakanuma Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Center HospitalSunto-gunShizuoka 4118777Japan Division of Diagnostic Pathology Shizuoka Cancer Center HospitalSunto-gunShizuoka 4118777japan

We report a case of a 75-year-old man with cystic micropapillary neoplasm of peribiliary glands detected preoperatively by radiologic examination. Enhanced computed tomography showed a low-density mass 2.2 cm in diameter in the right hepatic hilum and a cystic lesion around the common hepatic duct. cholangiocarcinoma, right hepatectomy with caudate lobectomy and bile duct resection were performed. Pathological examination revealed perihilar cholangiocarcinoma mainly involving the right hepatic duct. The cystic lesion was multilocular and covered by columnar lining epithelia exhibiting increased proliferative activity and p53 nuclear expression; it also contained foci of micropapillary and glandular proliferation. Therefore, the lesion was diagnosed as a cystic micropapillary neoplasm of peribiliary glands and resembled flat branch-type intraductal papillary mucinous neoplasm of the pancreas. Histological examination showed the lesion was discontinuous with the perihilar cholangiocarcinoma. Immunohistochemistry showed the cystic neoplasm was strongly positive for MUC6 and that the cholangiocarcinoma was strongly positive for MUC5 AC and S100 P. These results suggest these two lesions have different origins. This case warrants further study on whether this type of neoplasm is associated with concomitant cholangiocarcinoma as observed in pancreatic intraductal papillary mucinous neoplasm with concomitant pancreatic duct adenocarcinoma.

关键词： Intraductal papillary neoplasm of thebile duct Peribiliary gland Gastric type perihilar cholangiocarcinoma

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Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand

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World Journal of Gastrointestinal Oncology 2015年第12期7卷 503-512页

作者： Attapol Titapun Ake Pugkhem Vor Luvira Tharatip Srisuk Ongart Somintara O-tur Saeseow Anan Sripanuskul Anongporn Nimboriboonporn Bandit Thinkhamrop Narong Khuntikeo Department of Surgery Faculty of Medicine Khon Kaen University CASCAP Program Khon Kaen University Liver Fluke and Cholangiocarcinoma Research Center Faculty of Medicine Khon Kaen University Department of Epidemiology and Biostatistics Faculty of Public Health Khon Kaen University

AIM: To examine survival outcomes of perihilar cholangiocarcinoma(PCCA) resection including mortality, morbidity and prognostic factors. METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011. RESULTS: There were 29(19%) cases of intrahepatic CCA that involved hilar and 124(81%) with hilar bileduct cancer. R0 resection was carried out on 66(43.1%) patients of whom 50(32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6%(95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1. CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.

关键词： perihilar cholangiocarcinoma Thailand Curative res

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Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy

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Hepatobiliary & Pancreatic Diseases International 2019年第3期18卷 214-222页

作者： Fei Xiang Ze-Min Hu Department of General Surgery Jiangning Hospital of Nanjing Medical University Nanjing 211100 China Department of General Surgery Zhongshan People’s Hospital Zhongshan 528403 China

Background: The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) was first performed in 2007. The critical patient selection, timing to perform the second stage operation, and minimally invasive technique are three key factors for patient outcomes. The aim of this review is to summarize published data on these three aspects. Data sources: Studies were identified by searching Pub Med for articles published from January 2007 to October 2018, using the keywords “associating liver partition and portal vein ligation for staged hepatectomy” or “ALPPS” or “in situ split”. Studies on colorectal liver metastasis(CRLM), perihilar cholangiocarcinoma(PHC), and hepatocellular carcinoma(HCC) indicated for ALPPS, cutoff values to determine the timing of stage 2, as well as modifications of ALPPS were included. Results: The mortality of ALPPS for CRLM is declining, for PHC is high. In patients with HCC, essential hypertrophy makes the ALPPS safer. However, the degrees of fibrosis affect the hypertrophy. The future liver remnant volume is still the gold standard to start the second stage. Hepatobiliary scintigraphy plays an important role in quantitatively assessing liver function, whereas cutoff values need to be further calibrated. Less-invasive ALPPS modifications have increased and led to a decreased mortality. Conclusions: ALLPS improved the CRLM outcomes;ALPPS is feasible in patients with PHC after failure of portal vein embolization;ALPPS may be an option for HCC patients with major vascular invasion and thrombosis. The simplified and less-invasive ALPPS is the trend.

关键词： Hepatectomy Liver regeneration Portal vein Colorectal liver metastasis Hepatocellular carcinoma perihilar cholangiocarcinoma

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Pathological aspects of so called "hilar cholangiocarcinoma"

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World Journal of Gastrointestinal Oncology 2013年第7期5卷 159-170页

作者： Víctor M Castellano-Megías Carolina Ibarrola-de Andrés Francisco Colina-Ruizdelgado Department of Pathology Hospital Universitario de Fuenlabrada28041 MadridSpain. Department of Pathology Hospital Universitario "12 de Octubre"28041 MadridSpain.

Cholangiocarcinoma(CC) arising from the large intrahepatic bile ducts and extrahepatic hilar bile ducts share clinicopathological features and have been called hilar and perihilar CC as a group.However,"hilar and perihilar CC" are also used to refer exclusively to the intrahepatic hilar type CC or,more commonly,the extrahepatic hilar CC.Grossly,a major distinction can be made between papillary and non-papillary tumors.Histologically,most hilar CCs are well to moderately differentiated conventional type(biliary) carcinomas.Immunohistochemically,CK7,CK20,CEA and MUC1 are normally expressed,being MUC2 positive in less than 50% of cases.Two main premalignant lesions are known:biliary intraepithelial neoplasia(BilIN) and intraductal papillary neoplasm of the biliary tract(IPNB).IPNB includes the lesions previously named biliary papillomatosis and papillary carcinoma.A series of 29 resected hilar CC from our archives is reviewed.Most(82.8%) were conventional type adenocarcinomas,mostly well to moderately differentiated,although with a broad morphological spectrum;three cases exhibited a poorly differentiated cell component resembling signet ring cells.IPNB was observed in 5(17.2%),four of them with an associated invasive carcinoma.A clear cell type carcinoma,an adenosquamous carcinoma and two gastric foveolar type carcinomas were observed.

关键词： Cholangiocarcinoma Bile duct carcinoma Hilar cholangiocarcinoma perihilar cholangiocarcinoma Klatskin tumor Extrahepatic bile duct carcinoma Hepatic hilum

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Risk factors and classifications of hilar cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2013年第7期5卷 132-138页

作者： Miguel Angel Suarez-Munoz Jose Luis Fernandez-Aguilar Belinda Sanchez-Perez Jose Antonio Perez-Daga Beatriz Garcia-Albiach Ysabel Pulido-Roa Naiara Marin-Camero Julio Santoyo-Santoyo General Digestive and Transplantation Surgery Service HPB and Liver Transplant UnitUniversity Hospital Carlos Haya29010 MalagaSpain

Cholangiocarcinoma is the second most common primary malignant tumor of the liver.perihilar cholangiocarcinoma or Klatskin tumor represents more than 50% of all biliary tract cholangiocarcinomas.A wide range of risk factors have been identified among patients with perihilar cholangiocarcinoma including advanced age,male gender,primary sclerosing cholangitis,choledochal cysts,cholelithiasis,cholecystitis,parasitic infection(Opisthorchis viverrini and Clonorchis sinensis),inflammatory bowel disease,alcoholic cirrhosis,nonalcoholic cirrhosis,chronic pancreatitis and metabolic syndrome.Various classifications have been used to describe the pathologic and radiologic appearance of cholangiocarcinoma.The three systems most commonly used to evaluate perihilar cholangiocarcinoma are the Bismuth-Corlette(BC) system,the Memorial Sloan-Kettering Cancer Center and the TNM classification.The BC classification provides preoperative assessment of local spread.The Memorial Sloan-Kettering cancer center proposes a staging system according to three factors related to local tumor extent:the location and extent of bile duct involvement,the presence or absence of portal venous invasion,and the presence or absence of hepatic lobar atrophy.The TNM classification,besides the usual descriptors,tumor,node and metastases,provides additional information concerning the possibility for the residual tumor(R) and the histological grade(G).Recently,in 2011,a new consensus classification for the perihilar cholangiocarcinoma had been published.The consensus was organised by the European Hepato-PancreatoBiliary Association which identified the need for a new staging system for this type of tumors.The classification includes information concerning biliary or vascular(portal or arterial) involvement,lymph node status or metastases,but also other essential aspects related to the surgical risk,such as remnant hepatic volume or the possibility of underlying disease.

关键词： Hilar cholangiocarcinoma Klatskin tumor perihilar cholangiocarcinoma Bile duct cancer

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Hilar cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2013年第7期5卷 113-114页

作者： José M Ramia Department of Surgery Hospital Universitario de Guadalajara19002 GuadalajaraSpain

Hilar cholangiocarcinoma(HC) is a rare tumor.It accounts for 2/3 of the tumors of the biliary tract.Untreated,prognosis is very poor.Surgery is the only therapy that offers the possibility of cure but is technically very complex.With recent improvements in the therapeutic strategies applied by multidisciplinary teams,survival rates in the different series currently range from 25% to 45%.A group of experts devoted to HC(pathologists,gastroenterologists,radiologists,surgeons and oncologists) have reviewed and updated every open question in HC in a special issue.

关键词： Cholangiocarcinoma Hilar perihilar Klatskin Surgery Cancer Review

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