RSS-Feed abonnieren
DOI: 10.1055/s-2004-828895
Surgical Management of Cholangiocarcinoma
Publikationsverlauf
Publikationsdatum:
11. Juni 2004 (online)
![](https://www.thieme-connect.de/media/sld/200402/lookinside/thumbnails/10.1055-s-2004-828895-1.jpg)
Biliary tract cancer affects approximately 7500 Americans each year. Tumors arising from the gallbladder are the most common; those of bile duct origin, or cholangiocarcinoma, are less frequently encountered, constituting approximately 2% of all reported cancers. Although cholangiocarcinoma can arise anywhere within the biliary tree, tumors involving the biliary confluence (i.e., hilar cholangiocarcinoma) represent the majority, accounting for 40 to 60% of all cases. Twenty to 30% of cholangiocarcinomas originate in the lower bile duct, and approximately 10% arise within the intrahepatic biliary tree and will present as an intrahepatic mass. Complete resection remains the most effective and only potentially curative therapy for cholangiocarcinoma. For all patients with intrahepatic cholangiocarcinoma and nearly all patients with hilar tumors, complete resection requires a major partial hepatectomy. Distal cholangiocarcinomas, on the other hand, are treated like all periampullary malignancies and typically require pancreaticoduodenectomy. Most patients with cholangiocarcinoma present with advanced disease that is not amenable to surgical treatment, and even with a complete resection, recurrence rates are high. Adjuvant therapy (chemotherapy and radiation therapy) has not been shown clearly to reduce recurrence risk.
KEYWORDS
Cholangiocarcinoma - resection - surgery
REFERENCES
- 1 Carriaga M T, Henson D E. Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer. 1995; 75 171-190
- 2 Kuwayti K, Baggenstoss A H, Stauffer M H, Priestly J I. Carcinoma of the major intrahepatic and extrahepatic bile ducts exclusive of the papilla of Vater. Surg Gynecol Obstet. 1957; 104 357-366
- 3 Burke E C, Jarnagin W R, Hochwald S N et al.. Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg. 1998; 228 385-394
- 4 Fong Y, Blumgart L H, Lin E, Fortner J G, Brennan M F. Outcome of treatment for distal bile duct cancer. Br J Surg. 1996; 83 1712-1715
- 5 Nagorney D M, Donohue J H, Farnell M B, Schleck C D, Ilstrup D M. Outcomes after curative resections of cholangiocarcinoma. Arch Surg. 1993; 128 871-879
- 6 Nakeeb A, Pitt H A, Sohn T A et al.. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg. 1996; 224 463-473
- 7 Tompkins R K, Thomas D, Wile A, Longmire W P. Prognostic factors in bile duct carcinoma. Analysis of 96 cases. Ann Surg. 1981; 194 447-457
- 8 Yeo C J, Cameron J L, Sohn T A et al.. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997; 226 248-257
- 9 Berdah S V, Delpero J R, Garcia S, Hardwigsen J, Le Treut Y P. A western surgical experience of peripheral cholangiocarcinoma. Br J Surg. 1996; 83 1517-1521
- 10 Chu K M, Lai E C, al-Hadeedi S Y et al.. Intrahepatic cholangiocarcinoma. World J Surg. 1997; 21 301-306
- 11 Harrison L E, Fong Y, Klimstra D S, Zee S Y, Blumgart L H. Surgical treatment of 32 patients with peripheral intrahepatic cholangiocarcinoma. Br J Surg. 1998; 85 1068-1070
- 12 Shaib Y, El-Serag H B. The epidemiology of cholangiocarcinoma. Semin Liver Dis. 2004; 24 115-126
- 13 Berthiaume E P, Wands J. The molecular pathogenesis of cholangiocarcinoma. Semin Liver Dis. 2004; 24 127-138
- 14 Broome U, Olsson R, Loof L et al.. Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis. Gut. 1996; 38 610-615
- 15 Pitt H A, Dooley W C, Yeo C J, Cameron J L. Malignancies of the biliary tree. Curr Probl Surg. 1995; 32 1-90
- 16 Lipsett P A, Pitt H A, Colombani P M, Boitnott J K, Cameron J L. Choledochal cyst disease. A changing pattern of presentation. Ann Surg. 1994; 220 644-652
- 17 Kubo S, Kinoshita H, Hirohashi K, Hamba H. Hepatolithiasis associated with cholangiocarcinoma. World J Surg. 1995; 19 637-641
- 18 Watanapa P. Cholangiocarcinoma in patients with opisthorchiasis. Br J Surg. 1996; 83 1062-1064
- 19 Okuda K, Kubo Y, Okazaki N et al.. Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma. A study of 57 autopsy proven cases. Cancer. 1977; 39 232-246
- 20 Sako S, Seitzinger G L, Garside E. Carcinoma of the extrahepatic ducts. Review of the literature and report of six cases. Surgery. 1957; 41 416-417
- 21 Weinbren K, Mutum S S. Pathological aspects of cholangiocarcinoma. J Pathol. 1983; 139 217-238
- 22 Guthrie J A, Ward J, Robinson P J. Hilar cholangiocarcinomas: T2-weighted spin-echo and gadolinium-enhanced FLASH MR imaging. Radiology. 1996; 201 347-351
- 23 Itoh K, Fujita N, Kubo K et al.. MR imaging of hilar cholangiocarcinoma-comparative study with CT [in Japanese]. Nippon Igaku Hoshasen Gakkai Zasshi. 1992; 52 443-451
- 24 Lee M G, Lee H J, Kim M H et al.. Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography. Radiology. 1997; 202 663-669
- 25 Schwartz L H, Coakley F V, Sun Y et al.. Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography. AJR Am J Roentgenol. 1998; 170 1491-1495
- 26 Wetter L A, Ring E J, Pellegrini C A, Way L W. Differential diagnosis of sclerosing cholangiocarcinomas of the common hepatic duct (Klatskin tumors). Am J Surg. 1991; 161 57-62
- 27 Lai E C, Mok F P, Fan S T et al.. Preoperative endoscopic drainage for malignant obstructive jaundice. Br J Surg. 1994; 81 1195-1198
- 28 Pitt H A, Gomes A S, Lois J F et al.. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost?. Ann Surg. 1985; 201 545-553
- 29 Hochwald S N, Burke E C, Jarnagin W R, Fong Y, Blumgart L H. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg. 1999; 134 261-266
- 30 Sarmiento J M, Nagorney D M. Hepatic resection in the treatment of perihilar cholangiocarcinoma. Surg Oncol Clin N Am. 2002; 11 893-908
- 31 Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992; 215 31-38
- 32 Jarnagin W R, Fong Y, DeMatteo R P et al.. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001; 234 507-519
- 33 Weber S M, DeMatteo R P, Fong Y, Blumgart L H, Jarnagin W R. Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients. Ann Surg. 2002; 235 392-399
- 34 Cameron J L, Pitt H A, Zinner M J, Kaufman S L, Coleman J. Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am J Surg. 1990; 159 91-97
- 35 Gerhards M F, van Gulik T M, de Wit L T, Obertop H, Gouma D J. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma-a single center experience. Surgery. 2000; 127 395-404
- 36 Su C H, Tsay S H, Wu C C et al.. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg. 1996; 223 384-394
- 37 Hadjis N S, Blenkharn J I, Alexander N, Benjamin I S, Blumgart L H. Outcome of radical surgery in hilar cholangiocarcinoma. Surgery. 1990; 107 597-604
- 38 Klempnauer J, Ridder G J, von Wasielewski R et al.. Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol. 1997; 15 947-954
- 39 Neuhaus P, Jonas S, Bechstein W O et al.. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999; 230 808-818
- 40 Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg. 1999; 230 663-671
- 41 Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg. 1990; 14 535-543
- 42 Mizumoto R, Suzuki H. Surgical anatomy of the hepatic hilum with special reference to the caudate lobe. World J Surg. 1988; 12 2-10
- 43 Kawasaki S, Makuuchi M, Miyagawa S, Kakazu T. Radical operation after portal embolization for tumor of hilar bile duct. J Am Coll Surg. 1994; 178 480-486
- 44 Makuuchi M, Thai B L, Takayasu K et al.. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990; 107 521-527
- 45 Nagino M, Nimura Y, Kamiya J et al.. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery. 1995; 117 677-681
- 46 Kitagawa Y, Nagino M, Kamiya J et al.. Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg. 2001; 233 385-392
- 47 Kamada T, Saitou H, Takamura A, Nojima T, Okushiba S I. The role of radiotherapy in the management of extrahepatic bile duct cancer: an analysis of 145 consecutive patients treated with intraluminal and/or external beam radiotherapy. Int J Radiat Oncol Biol Phys. 1996; 34 767-774
- 48 McMasters K M, Tuttle T M, Leach S D et al.. Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma. Am J Surg. 1997; 174 605-608
- 49 Pitt H A, Nakeeb A, Abrams R A et al.. Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival. Ann Surg. 1995; 221 788-797
- 50 Jarnagin W R, Burke E, Powers C, Fong Y, Blumgart L H. Intrahepatic biliary enteric bypass provides effective palliation in selected patients with malignant obstruction at the hepatic duct confluence. Am J Surg. 1998; 175 453-460
- 51 Kuvshinoff B W, Armstrong J G, Fong Y et al.. Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy. Br J Surg. 1995; 82 1522-1525
- 52 Bowling T E, Galbraith S M, Hatfield A R, Solano J, Spittle M F. A retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma. Gut. 1996; 39 852-855
- 53 Wade T P, Prasad C N, Virgo K S, Johnson F E. Experience with distal bile duct cancers in U.S. Veterans Affairs hospitals: 1987-1991. J Surg Oncol. 1997; 64 242-245
- 54 Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology. 2001; 33 1353-1357
- 55 Kokudo N, Makuuchi M. Extent of resection and outcome after curative resection for intrahepatic cholangiocarcinoma. Surg Oncol Clin N Am. 2002; 11 969-983
- 56 Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Liver Cancer Study Group of Japan . Ann Surg. 1990; 211 277-287
- 57 Kobayashi M, Ikeda K, Saitoh S et al.. Incidence of primary cholangiocellular carcinoma of the liver in japanese patients with hepatitis C virus-related cirrhosis. Cancer. 2000; 88 2471-2477
- 58 Yamasaki S. Intrahepatic cholangiocarcinoma: macrosopic type and stage classification. J HBP Surg. 2003; 10 288-291
- 59 Ohtsuka M, Ito H, Kimura F et al.. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg. 2002; 89 1525-1531
- 60 Okabayashi T, Yamamoto J, Kosuge T et al.. A new staging system for mass-forming intrahepatic cholangiocarcinoma: analysis of preoperative and postoperative variables. Cancer. 2001; 92 2374-2383
- 61 Weber S M, Jarnagin W R, Klimstra D et al.. Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg. 2001; 193 384-391
- 62 Pichlmayr R, Lamesch P, Weimann A, Tusch G, Ringe B. Surgical treatment of cholangiocellular carcinoma. World J Surg. 1995; 19 83-88
- 63 Jan Y Y, Jeng L B, Hwang T L et al.. Factors influencing survival after hepatectomy for peripheral cholangiocarcinoma. Hepatogastroenterology. 1996; 43 614-619
- 64 Casavilla F A, Marsh J W, Iwatsuki S et al.. Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg. 1997; 185 429-436
- 65 Madariaga J R, Iwatsuki S, Todo S et al.. Liver resection for hilar and peripheral cholangiocarcinomas: a study of 62 cases. Ann Surg. 1998; 227 70-79
- 66 Valverde A, Bonhomme N, Farges O et al.. Resection of intrahepatic cholangiocarcinoma: a western experience. J Hepatobiliary Pancreat Surg. 1999; 6 122-127
- 67 Inoue K, Makuuchi M, Takayama T et al.. Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery. 2000; 127 498-505
- 68 Isa T, Kusano T, Shimoji H et al.. Predictive factors for long-term survival in patients with intrahepatic cholangiocarcinoma. Am J Surg. 2001; 181 507-511
William R JarnaginM.D.
Department of Surgery, Memorial Sloan-Kettering Cancer Center
1275 York Ave
New York, NY 10021
eMail: jarnagiw@mskcc.org