Surgery of extrahepatic bile duct cancer – current evidence and recommendations

Česká verze

Authors: A. Nikov; R. Gürlich
Authors place of work: Chirurgická klinika Fakultní nemocnice Královské Vinohrady a 3. Lékařské fakulty Univerzity Karlovy, Praha
Published in the journal: Rozhl. Chir., 2022, roč. 101, č. 9, s. 416-420.
Category: Souhrnné sdělení
doi: https://doi.org/10.33699/PIS.2022.101.9.416–420

Summary

Extrahepatic cholangiocarcinoma is a rare disease with poor prognosis, requiring comprehensive multidisciplinary management. Only radical resection gives hope for long-term survival. Most patients have either an unresectable disease or their condition does not allow for radical surgery. The method of choice for resectable perihilar cholangiocarcinoma is en-block liver resection including the extrahepatic bile duct, or pancreatoduodenectomy for distal cholangiocarcinoma. Hepatopancreatoduodenectomy can be performed in selected patients if the entire hepato-choledochus is affected. Liver transplantation after neoadjuvant treatment can be also considered in highly selected patients with unresectable perihilar cholangiocarcinoma. These procedures are technically demanding, are associated with high morbidity and relevant mortality, and must be concentrated in tertiary hepatobiliary centers. Preoperative optimization (bile duct drainage, nutrition, portal venous embolization, etc.) plays a crucial role in reducing postoperative morbidity and mortality.

Keywords:

cholangiocarcinoma – extrahepatic – Hepatectomy – pancreatoduodenectomy – bile duct

Zdroje

1. Mizuno T, Ebata T, Nagino M. Advanced hilar cholangiocarcinoma: An aggressive surgical approach for the treatment of advanced hilar cholangiocarcinoma: Perioperative management, extended procedures, and multidisciplinary approaches. Surgical Oncology 2020;33:201−206. doi:10.1016/j.suronc. 2019.07.002.

2. Bismuth H Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Annals of Surgery 1992;215(1):31−38. doi:10.1097/00000658-199201000- 00005.

3. Yamada M, Mizuno T, Yamaguchi J, et al. Superiority of clinical American Joint Committee on Cancer T classification for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2021. doi:10.1002/ jhbp.1066.

4. Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford) 2015; 17(8):691−699. doi:10.1111/hpb. 12450.

5. Nagino M, Hirano S, Yoshitomi H, et al. Clinical practice guidelines for the management of biliary tract cancers 2019: The 3rd English edition. J Hepatobiliary Pancreat Sci. 2021;28(1):26−54. doi:10.1097/ sla.0000000000004986.

6. Lim JH, Choi GH, Choi SH, et al. Liver resection for Bismuth Type I and Type II hilar cholangiocarcinoma. World J Surg. 2013;37(4):829−837. doi:10.1007/ s00268-013-1909-9.

7. Gazzaniga GM, Filauro M, Bagarolo C, et al. Surgery for hilar cholangiocarcinoma: an Italian experience. Journal of Hepato-Biliary-Pancreatic Surgery 2000;7(2):122−127. doi: 10.1007/ s005340050165.

8. Lee SG, Song GW, Hwang S, et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci. 2010;17(4):476−489. doi: 10.1007/ s00534-009-0204-5.

9. Capussotti L, Vigano L, Ferrero A, et al. Local surgical resection of hilar cholangiocarcinoma: Is there still a place? HPB 2008;10(3):174−178. doi:10.1080/13651820801992534.

10. Cheng QB, Yi B, Wang JH, et al. Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type III and IV. Eur J Surg Oncol. 2012;38(12):1197−1203. doi:10.1016/j.ejso.2012.08.009.

11. Kow AW, Wook CD, Song SC, et al. Role of caudate lobectomy in type III A and III B hilar cholangiocarcinoma: a 15- year experience in a tertiary institution. World J Surg. 2012;36(5):1112−1121. doi:10.1007/s00268-012-1497-0.

12. Wahab MA, Sultan AM, Salah T, et al. Caudate lobe resection with major hepatectomy for central cholangiocarcinoma: is it of value? Hepatogastroenterology 2012;59(114):321−324. doi:10.5754/hge 11999.

13. Passeri MJ, Baimas-George MR, Sulzer JK, et al. Prognostic impact of the Bismuth- Corlette classification: Higher rates of local unresectability in stage IIIb hilar cholangiocarcinoma. Hepatobiliary Pancreat Dis Int. 2020;19(2):157−162. doi:10.1016/j.hbpd.2020.02.001.

14. Ebata T, Mizuno T, Yokoyama Y, et al. Surgical resection for Bismuth type IV perihilar cholangiocarcinoma. Br J Surg. 2018;105(7):829−838. doi:10.1002/bjs. 10556.

15. Littau MJ, Kim P, Kulshrestha S, et al. Resectable intrahepatic and hilar cholangiocarcinoma: Is margin status associated with survival? Surgery 2022;171(3):703−710. doi: org/10.1016/j. surg.2021.09.038.

16. Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227(3):405−411. doi:10.1097/00000658-199803000- 00013.

17. Seyama Y, Kubota K, Sano K, et al. Longterm outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238(1):73−83. doi:10.1097/01. Sla.0000074960.55004.72.

18. Ebata T, Watanabe H, Ajioka Y, et al. Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg. 2002, 89(10):1260-1267. doi:10.1046/j.1365- 2168.2002.02211.x.

19. Ma WJ, Wu ZR, Shrestha A, et al. Effectiveness of additional resection of the invasive cancer-positive proximal bile duct margin in cases of hilar cholangiocarcinoma. Hepatobiliary Surg Nutr. 2018;7(4):251−269. doi:10.21037/ hbsn.2018.03.14.

20. Otsuka S, Ebata T, Yokoyama Y, et al. Clinical value of additional resection of a margin-positive distal bile duct in perihilar cholangiocarcinoma. British Journal of Surgery 2019;106(6):774−782. doi:10.1002/bjs.11125.

21. Zhang XF, Squires MH, 3rd, Bagante F, et al. The impact of intraoperative re-resection of a positive bile duct margin on clinical outcomes for hilar cholangiocarcinoma. Ann Surg Oncol. 2018;25(5):1140−1149. doi:10.1245/ s10434-018-6382-0.

22. Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma. Annals of Surgery 1999; 230(6):808−819. doi:10.1097/00000658- 199912000-00010.

23. Neuhaus P, Thelen A, Jonas S, et al. Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma. Annals of Surgical Oncology 2012;19(5):1602−1608. doi:10.1245/ s10434-011-2077-5.

24. Nagino M, Clavien P-A. Demise of hilar en bloc resection by no-touch technique as surgery for perihilar cholangiocarcinoma: Dissociation between theory and practice. Annals of Surgery 2021;274(5):e385−e387. doi:10.1002/ jhbp.870.

25. Hewitt DB, Brown ZJ, Pawlik TM. Surgical management of cholangiocarcinoma. Hepatoma Research 2021;7:75. doi:10.20517/2394-5079.2021.83.

26. Lauterio A, De Carlis R, Centonze L, et al. Current surgical management of peri-hilar and intra-hepatic cholangiocarcinoma. Cancers (Basel) 2021;13(15). doi:10.3390/cancers13153657.

27. Abulkhir A, Limongelli P, Healey AJ, et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg. 2008;247(1):49−57. doi:10.1097/SLA.0b013e31815f6e5b.

28. Palavecino M, Abdalla EK, Madoff DC, et al. Portal vein embolization in hilar cholangiocarcinoma. Surg Oncol Clin N Am. 2009;18(2):257−267, viii. doi:10.1016/j. soc.2008.12.007.

29. Cillo U, Fondevila C, Donadon M, et al. Surgery for cholangiocarcinoma. Liver Int. 2019;39 Suppl 1(Suppl Suppl 1):143−155. doi:10.1111/liv.14089.

30. Darwish MS, Kim WR, et al. Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers. Gastroenterology 2011;143(1):88−98. e83; quiz e14. doi:10.1053/j.gastro. 2012.04.008.

31. Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma. Transpl Int. 2010;23(7):692−697. doi:10.1111/j.1432-2277.2010.01108.x.

32. Chen Z, Yu B, Bai J, et al. The impact of intraoperative frozen section on resection margin status and survival of patients underwent pancreatoduodenectomy for distal cholangiocarcinoma. Front Oncol. 2021; 11:650585. doi:10.3389/ fonc.2021.650585.

33. Maeta T, Ebata T, Hayashi E, et al. Pancreatoduodenectomy with portal vein resection for distal cholangiocarcinoma. British Journal of Surgery 2017;104(11):1549−1557. doi:10.1002/ bjs.10596.

34. Ebata T, Yokoyama Y, Igami T, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg. 2012;256(2):297−305. doi:10.1097/SLA. 0b013e31826029ca.

35. D’Souza MA, Valdimarsson VT, Campagnaro T, et al. Hepatopancreatoduodenectomy − a controversial treatment for bile duct and gallbladder cancer from a European perspective. HPB (Oxford) 2020;22(9):1339−1348. doi:10.1016/j. hpb.2019.12.008.

36. Welch JC, Gleeson EM, Karachristos A, et al. Hepatopancreatoduodenectomy in North America: are the outcomes acceptable? HPB (Oxford) 2020;22(3):360−367. doi:10.1016/j.hpb.2019.08.010.