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Langenbeck's Archives of Surgery

Published in:

01-08-2014 | Review Article

Surgical resection techniques for locally advanced hilar cholangiocarcinoma

Authors: Sanjay Govil, Mettu Srinivas Reddy, Mohamed Rela

Published in: Langenbeck's Archives of Surgery | Issue 6/2014

Abstract

Background

Resection of perihilar cholangiocarcinoma involves major hepatectomy including caudate lobectomy. It is technically challenging because of the complex, intimate and variable relationship between biliary and vascular structures in the liver hilum. Resectability rates vary from 30 to 80 % and about one third of patients have microscopically involved margins. However, adequately performed resections provide 5-year survival of 30–40 % and are worth pursuing.

Purpose

Better understanding of anatomy, better imaging, improved surgical techniques and progress in perioperative care of these patients have pushed the limits of resection of these tumours. Many of the traditional indicators of inoperability such as bilateral involvement of second-order hepatic ducts, contralateral biliary and vascular involvement, and need for arterial resection have been overcome or are being challenged. This review discusses techniques that may increase margin-free resectability of Bismuth–Corlette type III and IV perihilar cholangiocarcinoma.

Conclusion

Advanced perihilar cholangiocarcinoma requires extended liver resection and often vascular resection, despite which the margin may be compromised in about one third of patients. Right sided tumours are likely to need right trisectionectomy and portal vein resection, best served by an en bloc hilar resection or Rex-recess approach. Left-sided tumours often involve contralateral blood vessels and require left trisegmentectomy with possible right portal vein or right hepatic artery reconstruction. These tumours are best tackled by hepatobiliary surgeons with experience in microvascular techniques. Salvage procedures when arterial reconstruction is not feasible are still under evaluation.

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Title: Surgical resection techniques for locally advanced hilar cholangiocarcinoma
Authors: Sanjay Govil
Mettu Srinivas Reddy
Mohamed Rela
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 6/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1216-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical resection techniques for locally advanced hilar cholangiocarcinoma

Abstract

Background

Purpose

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Conclusion

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