Surgical Treatment of Hilar and Intrahepatic Cholangiocarcinoma

Front Cover
Alfredo Guglielmi, Andrea Ruzzenente, Calogero Iacono
Springer Science & Business Media, Nov 21, 2007 - Medical - 241 pages

Cholangiocarcinoma is the second most frequent primary neoplasm of the liver and its incidence is increasing in Western countries. These neoplasms arise from the biliary tract and can be categorized according to their anatomical location as intrahepatic and extrahepatic cholangiocarcinomas. The prognosis of these neoplasms is poor and most patients are not suitable for curative resection at the time of diagnosis ,due to advanced stage of tumor. Complete surgical resection still remains the only effective and potentially curative therapy. Both intrahepatic and hilar cholangiocarcinoma often requires major liver resection to obtain a radical treatment. In recent years the improvements in non- invasive diagnostic imaging modalities, a better understanding of liver anatomy, the improvements of preoperative optimisation of liver function (preoperative biliary drainage, portal vein embolization), the increased safety of liver surgery have gradually improved the outcome. Moreover, aggressive surgical approach could increase curative surgery. Still now the role of adjunvant therapies and liver transplantation are not well clarified.

This book contains an up-to-date review of diagnostic and staging tools of cholangiocarcinoma, a guide to optimal selection of therapeutic modalities and a review of long-term outcome of surgery and liver transplantation. Moreover, it provides details of surgical techniques and principles for curative and palliative surgery.

This book will appeal to physicians and hepatobiliary surgeons who want to improve their knowledge about surgical management of intrahepatic and hilar cholangiocarcinomas.

 

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Contents

Pathological Aspects
3
Clinical Information
4
Intraoperative Consultation
5
Macroscopic Examination
6
Pathology Findings in NonNeoplastic Liver
9
Lymph Nodes Location Number
10
Additional Pathology Findings
12
Immunohistochemistry
13
Central Hepatic Resections
123
Extended Right Resections
124
Extended Left Resections
125
Surgical Technique
129
Intraoperative Exploration
130
Bile Duct Resection Alone
131
Independent Caudate Lobectomy S1
132
Right Hepatectomy with Caudate Lobectomy S4a S5 S6 S7 S8 + S1
133

Diagnosis
17
Computed Tomography
20
Magnetic Resonance Imaging
21
Positron Emission Tomography
23
Cholangioscopy Peroral Percutaneous
24
Angiography
25
Preoperative Staging
29
Evaluation of the Biliary Involvement Longitudinal Extent
30
Vascular Involvement Parenchymal Involvement and Hepatic Lobar Atrophy
33
Preoperative Assessment of Tumour Resectability T
35
Evaluation of Lymph Node Status N
36
Evaluation of Metastases M
37
The Role of Laparoscopy in Preoperative Staging
43
Results
44
Laparoscopic Ultrasound
45
Conclusions
46
Preoperative Assessment of Liver Function
49
Preoperative Biliary Drainage
57
Pros
58
Cons
59
Conclusions
62
Preoperative Portal Vein Embolization
67
Indications
69
Results
71
PostPVE Course and Timing of Resection
72
Prognostic Factors
75
Microscopic Pattern
76
T Category
77
N Category
81
M Category
82
Staging Systems
87
TNM Staging System According to UICCAJCC 6th Edition
88
Comparison between 5th and 6th Edition of TNM UICCAJCC
91
Early Cancer
96
Memorial SloanKettering Cancer Center Staging
98
Conclusions
99
Surgical Anatomy of the Hepatic Hilus
101
Anatomy of the Bile Duct Branches
102
Anatomy of the Portal Vein Branches
105
Anatomy of the Hepatic Artery Branches
107
Surgical Anatomy of the Caudate Lobe
108
Surgical Treatment
113
Assessment of Resectability
115
Indication for Surgical Resection
120
Isolated Extrahepatic Bile Duct Resection
121
Independent Caudate Lobectomy S1
122
Right Trisectionectomy with Caudate Lobectomy S4 S5 S6 S7 S8 + S1
135
Left Hepatectomy with Caudate Lobectomy S2 S3 S4 + S1
138
Left Trisectionectomy with Caudate Lobectomy S2 S3 S4 S5 S8 + S1
139
Central Preserving Hepatectomy
141
Hepatectomy with Portal Resection and Reconstruction
143
Hepatectomy with Arterial Resection and Reconstruction
148
Hepatopancreatoduodenectomy HPD
149
Biliary Anastomosis
150
Results of Surgery
153
Longterm Results
157
Recurrence
159
The Role of Liver Transplantation
163
Combined Transplantation
165
Transplantation with Adjuvant and Neoadjuvant Treatments
166
Conclusions
167
Adjuvant and Neoadjuvant Therapies
169
Radiotherapy
170
Neoadjuvant Therapy
171
Conclusions
172
Palliative Treatments
175
Chemotherapy Radiotherapy and Photodynamic Therapy
179
Intrahepatic Cholangiocarcinoma
185
Diagnosis
187
Computed Tomography
188
Magnetic Resonance Imaging
190
Angiography
192
Prognostic Factors
193
T Category
195
N Category
196
Microscopic Pattern
199
Staging Systems
203
TNM Classification According to the LCSGJ
206
Conclusions
210
Surgical Treatment
213
Indications for Surgical Resection
214
Indications for Lymphadenectomy
217
Extrahepatic Metastases
219
Results of Surgery
221
LongTerm Survival
222
Recurrence
226
The Role of Liver Transplantation
229
Adjuvant and Palliative Treatments
233
Palliative Therapy Chemotherapy
235
Subject Index
239
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