Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma.
Fumihiro KawanoRyuji YoshiokaHirofumi IchidaYoshihiro MiseAkio SaiuraPublished in: Annals of gastroenterological surgery (2023)
Resection is the only potential curative treatment for perihilar cholangiocarcinoma (PHC); however, complete resection is often technically challenging due to the anatomical location. Various innovative approaches and procedures were invented to circumvent this limitation but the rates of postoperative morbidity (20%-78%) and mortality (2%-15%) are still high. In patients diagnosed with resectable PHC, deliberate and coordinated preoperative workup and optimization of the patient and future liver remnant are crucial. Biliary drainage is recommended to relieve obstructive jaundice and optimize the clinical condition before liver resection. Biliary drainage for PHC can be performed either by endoscopic biliary drainage or percutaneous transhepatic biliary drainage. To date there is no consensus about which method is preferred. The volumetric assessment of the future remnant liver volume and optimization mainly using portal vein embolization is the gold standard in the management of the risk to develop post hepatectomy liver failure. The improvement of systemic chemotherapy has contributed to prolong the survival not only in patients with unresectable PHC but also in patients undergoing curative surgery. In this article, we review the literature and discuss the current surgical treatment of PHC.
Keyphrases
- ultrasound guided
- patients undergoing
- liver failure
- locally advanced
- prognostic factors
- end stage renal disease
- minimally invasive
- rectal cancer
- liver metastases
- current status
- newly diagnosed
- hepatitis b virus
- chronic kidney disease
- ejection fraction
- systematic review
- case report
- peritoneal dialysis
- coronary artery bypass
- squamous cell carcinoma
- patient reported outcomes
- risk assessment
- percutaneous coronary intervention
- free survival
- radiofrequency ablation
- replacement therapy