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09-06-2024 | Cholangiocarcinoma | ASO Author Reflections

ASO Author Reflections: Surgical Milestones in Hilar Cholangiocarcinoma: A Journey from Bismuth to the Future

Author: Jie Huang, PhD, MD

Published in: Annals of Surgical Oncology

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Excerpt

Hilar cholangiocarcinoma (HC) was first characterized by Altemeier et al. in 1957,1 and later popularized by Klatskin in 1965.2 The staging of HC was initially described by Bismuth and Corlette3 in 1975. Bismuth and Corlette classified HC into four types: type 1 involves the extrahepatic duct; type 2 involves the hilum; type 3A involves the hilum with the right duct and type 3B involves the hilum with the left duct; and type 4 involves the hilum along with both the right and left ductal systems (Fig. 1). Complete surgical resection remains the sole curative treatment for long-term survival. However, for Bismuth–Corlette type 4 (BC-IV) HC, achieving a negative margin resection (R0) is challenging and is associated with a high rate of immediate postoperative complications and recurrence or metastasis. Specifically, due to the disease’s spread along both sides of the hepatic biliary tree, BC-IV tumors have historically exhibited unfavorable surgical outcomes owing to the requirement for extended hepatectomies, which, in addition to their inherent technical challenges, are associated with significant morbidity. Indeed, the natural history of this disease has led both the 2010 American Joint Committee on Cancer (AJCC) Cancer Staging Manual and the 2011 European Society for Medical Oncology to regard BC-IV disease as a criterion for unresectability.
Literature
1.
go back to reference Altemeier WA, Gall EA, Zinninger MM, Hoxworth PI. Sclerosing carcinoma of the major intrahepatic bile ducts. AMA Arch Surg. 1957;75:450–60 (discussion 460-461).CrossRefPubMed Altemeier WA, Gall EA, Zinninger MM, Hoxworth PI. Sclerosing carcinoma of the major intrahepatic bile ducts. AMA Arch Surg. 1957;75:450–60 (discussion 460-461).CrossRefPubMed
2.
go back to reference Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med. 1965;38:241–56.CrossRefPubMed Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med. 1965;38:241–56.CrossRefPubMed
3.
go back to reference Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140:170–8.PubMed Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140:170–8.PubMed
Metadata
Title
ASO Author Reflections: Surgical Milestones in Hilar Cholangiocarcinoma: A Journey from Bismuth to the Future
Author
Jie Huang, PhD, MD
Publication date
09-06-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15581-6
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