Progress in diagnosis and treatment of hilar cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENG Pengrui ,  SU Yang

Department of Hepatobiliary and Splenic Surgery, The Affiliated Shengjing Hospital of China Medical University, Shenyang 110001, P. R. China;

Corresponding author：

SU Yang, Email: suyang_1973@163.com

Keywords：

hilar cholangiocarcinoma; diagnosis; preoperative evaluation; treatment; review

DOI：

10.7507/1007-9424.201804058

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the progress in diagnosis and treatment of hilar cholangiocarcinoma at present. Methods The literatures about diagnosis and treatment of hilar cholangiocarcinoma at home and aboard were collected to make an review. Results The diagnosis of hilar cholangiocarcinoma mainly depended on serum tumor molecular markers and imaging examinations. Preoperative excision and prognostic evaluation were required, including tumor classification and staging, preoperative yellow reduction, residual liver volume assessment, and so on. Radical resection was the first choice, as well as liver transplantation, radiotherapy, chemotherapy, and photodynamic therapy could be selected according to the patient’s condition. Conclusions The appearance of new diagnosis and treatment technology promotes the clinical development of hilar cholangiocarcinoma. The integrated diagnosis and treatment mode, which is based on surgery, will become the inevitable direction of the development of hilar cholangiocarcinoma.

Citation： CHENG Pengrui, SU Yang. Progress in diagnosis and treatment of hilar cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1398-1402. doi: 10.7507/1007-9424.201804058 Copy

1.	李斌, 张柏和, 姜小清. 解读不同指南与共识的热点及分歧、重视肝门部胆管癌的规范化诊疗. 中国普外基础与临床杂志, 2016, 23(11): 1293-1298.
2.	Berardi R, Mocchegiani F, Pierantoni C, et al. Resected biliary tract cancers: a novel clinical-pathological score correlates with global outcome. Dig Liver Dis, 2013, 45(1): 70-74.
3.	苏德望, 付先东, 于佳楠, 等. 血清糖类抗原 19-9、癌胚抗原在胆管癌诊断中的应用价值. 中国实验诊断学, 2017, 21(10): 1693-1695.
4.	Chen P, Li B, Zhu Y, et al. Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma. Oncotarget, 2016, 7(24): 37319-37330.
5.	Lederer A, Herrmann P, Seehofer D, et al. Metastasis-associated in colon cancer 1 is an independent prognostic biomarker for survival in Klatskin tumor patients. Hepatology, 2015, 62(3): 841-850.
6.	陈雄飞, 周宁新, 张红红. FXYD6 在肝门胆管癌中的表达及临床意义. 中国普外基础与临床杂志, 2016, 23(11): 1344-1347.
7.	Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: recent advances and challenges. Radiology, 2018, 288(1): 7-13.
8.	Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
9.	倪其泓, 张赟和, 何敏, 等. 多排螺旋 CT 三维重建技术在肝门部胆管癌术前可切除性评估与手术规划中的应用. 中华肝胆外科杂志, 2016, 22(7): 489-490.
10.	林科灿, 曾永毅, 黎蕴通, 等. 三维重建虚拟手术规划在肝门部胆管癌手术中的应用价值. 中华消化外科杂志, 2018, 17(4): 383-388.
11.	张成军. 常规磁共振成像联合磁共振胰胆管成像对肝门部胆管癌的诊断价值. 新乡医学院学报, 2018, 35(3): 235-238.
12.	Lee DH, Lee JM, Hur BY, et al. Colorectal cancer liver metastases: diagnostic performance and prognostic value of PET/MR imaging. Radiology, 2016, 280(3): 782-792.
13.	Ma KW, Cheung TT, She WH, et al. Diagnostic and prognostic role of 18-FDG PET/CT in the management of resectable biliary tract cancer. World J Surg, 2018, 42(3): 823-834.
14.	修典荣, 王行雁. 肝门部胆管癌的精准外科诊疗进展. 国际外科学杂志, 2017, 44(7): 433-436.
15.	毛谅, 陈骏, 孙士全, 等. 美国癌症联合委员会肝门部胆管癌分期系统 (第 8 版) 更新解读. 中国实用外科杂志, 2017, 37(5): 510-513.
16.	Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg, 1992, 215(1): 31-38.
17.	中国抗癌协会. 肝门部胆管癌规范化诊治专家共识 (2015). 中华肝胆外科杂志, 2015, 21(8): 505-511.
18.	Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg, 2001, 234(4): 507-517.
19.	Zaydfudim VM, Clark CJ, Kendrick ML, et al. Correlation of staging systems to survival in patients with resected hilar cholangiocarcinoma. Am J Surg, 2013, 206(2): 159-165.
20.	Deoliveira ML, Schulick RD, Nimura Y, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4): 1363-1371.
21.	王杰, 刘厚宝. 肝门部胆管癌术前胆道引流的现状和研究进展. 中华肝胆外科杂志, 2018, 24(1): 59-64.
22.	黄志强. 肝门部胆管癌外科治疗的现状与我见. 中国实用外科杂志, 2007, 27(5): 341-346.
23.	Kawakubo K, Kawakami H, Kuwatani M, et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma. World J Gastrointest Endosc, 2016, 8(9): 385-390.
24.	Jang SI, Hwang JH, Lee KH, et al. Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors. J Gastroenterol Hepatol, 2017, 32(4): 932-938.
25.	Dumitrascu T, Brasoveanu V, Stroescu C, et al. Major hepatectomies for perihilar cholangiocarcinoma: predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions. Asian J Surg, 2016, 39(2): 81-89.
26.	Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
27.	Marti J, Giacca M, Alshebeeb K, et al. Analysis of preoperative portal vein embolization outcomes in patients with hepatocellular carcinoma: a single-center experience. J Vasc Interv Radiol, 2018, 29(7): 920-926.
28.	杜成友, 肖衡. ALPPS 在原发性肝癌治疗中的价值和评价. 中国普外基础与临床杂志, 2017, 24(12): 1435-1441.
29.	赵帅, 王许安, 刘颖斌. 肝门胆管癌的外科争议及围肝门切除. 肝胆胰外科杂志, 2016, 28(4): 346-350.
30.	Robles R, Parrilla P, López-Conesa A, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg, 2014, 101(9): 1129-1134.
31.	张东, 陶杰, 耿智敏, 等. 联合半肝切除肝门部胆管癌 63 例预后分析. 西部医学, 2017, 29(7): 927-930, 934.
32.	董家鸿, 项灿宏, 石军, 等. 以围肝门切除为本的肝门胆管癌治愈性切除的临床分析. 中华消化外科杂志, 2017, 16(10): 1053-1060.
33.	吕少诚, 潘冰, 贺强. 联合肝脏切除术治疗 Bismuth Ⅲb 型肝门部胆管癌的技术要点. 国际外科学杂志, 2017, 44(4): 265-267.
34.	管小青, 顾书成, 吴骥, 等. 联合肝叶及入肝血管切除和重建治疗肝门部胆管癌的临床研究. 中国普外基础与临床杂志, 2015, 22(1): 64-69.
35.	黄庆国, 朱载阳, 李鹏泽. 扩大肝切除术治疗Ⅲ至Ⅳ期肝门胆管癌的临床价值. 癌症进展, 2017, 15(3): 325-327.
36.	Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut, 2012, 61(12): 1657-1669.
37.	Miyazaki M, Yoshitomi H, Miyakawa S, et al. Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition. J Hepatobiliary Pancreat Sci, 2015, 22(4): 249-273.
38.	中华医学会外科学分会胆道外科学组, 解放军全军肝胆外科专业委员会. 肝门部胆管癌诊断和治疗指南 (2013 版). 中华外科杂志, 2013, 51(10): 865-871.
39.	国际肝胆胰学会中国分会, 中华医学会外科学分会肝胆外科学组. 胆管癌诊断与治疗—外科专家共识. 临床肝胆病杂志, 2015, 31(1): 12-16.
40.	Olthof PB, Wiggers JK, Groot Koerkamp B, et al. Postoperative liver failure risk score: identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein emboli- zation. J Am Coll Surg, 2017, 225(3): 387-394.
41.	Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg, 2005, 242(3): 451-458.
42.	Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma. World J Gastroenterol, 2013, 19(48): 9209-9215.
43.	Loveday BPT, Knox JJ, Dawson LA, et al. Neoadjuvant hyperfractionated chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma in Canada. J Surg Oncol, 2018, 117(2): 213-219.
44.	Ghiassi-Nejad Z, Tarchi P, Moshier E, et al. Prognostic factors and patterns of locoregional failure after surgical resection in patients with cholangiocarcinoma without adjuvant radiation therapy: optimal field design for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys, 2017, 99(4): 805-811.
45.	Krasnick BA, Jin LX, Davidson JT 4^th, et al. Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: a multi-institution analysis from the U. S. extrahepatic biliary malignancy consortium. J Surg Oncol, 2018, 117(3): 363-371.
46.	李志海. 肝门部胆管癌经内镜置入金属支架结合局部放疗疗效分析. 中国实用医药, 2016, 11(4): 66-67.
47.	闫炫炫, 李多富, 李汛. 光动力疗法在不可切除肝门部胆管癌中的应用. 中国普外基础与临床杂志, 2018, 25(4): 488-492.

1. 李斌, 张柏和, 姜小清. 解读不同指南与共识的热点及分歧、重视肝门部胆管癌的规范化诊疗. 中国普外基础与临床杂志, 2016, 23(11): 1293-1298.
2. Berardi R, Mocchegiani F, Pierantoni C, et al. Resected biliary tract cancers: a novel clinical-pathological score correlates with global outcome. Dig Liver Dis, 2013, 45(1): 70-74.
3. 苏德望, 付先东, 于佳楠, 等. 血清糖类抗原 19-9、癌胚抗原在胆管癌诊断中的应用价值. 中国实验诊断学, 2017, 21(10): 1693-1695.
4. Chen P, Li B, Zhu Y, et al. Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma. Oncotarget, 2016, 7(24): 37319-37330.
5. Lederer A, Herrmann P, Seehofer D, et al. Metastasis-associated in colon cancer 1 is an independent prognostic biomarker for survival in Klatskin tumor patients. Hepatology, 2015, 62(3): 841-850.
6. 陈雄飞, 周宁新, 张红红. FXYD6 在肝门胆管癌中的表达及临床意义. 中国普外基础与临床杂志, 2016, 23(11): 1344-1347.
7. Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: recent advances and challenges. Radiology, 2018, 288(1): 7-13.
8. Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
9. 倪其泓, 张赟和, 何敏, 等. 多排螺旋 CT 三维重建技术在肝门部胆管癌术前可切除性评估与手术规划中的应用. 中华肝胆外科杂志, 2016, 22(7): 489-490.
10. 林科灿, 曾永毅, 黎蕴通, 等. 三维重建虚拟手术规划在肝门部胆管癌手术中的应用价值. 中华消化外科杂志, 2018, 17(4): 383-388.
11. 张成军. 常规磁共振成像联合磁共振胰胆管成像对肝门部胆管癌的诊断价值. 新乡医学院学报, 2018, 35(3): 235-238.
12. Lee DH, Lee JM, Hur BY, et al. Colorectal cancer liver metastases: diagnostic performance and prognostic value of PET/MR imaging. Radiology, 2016, 280(3): 782-792.
13. Ma KW, Cheung TT, She WH, et al. Diagnostic and prognostic role of 18-FDG PET/CT in the management of resectable biliary tract cancer. World J Surg, 2018, 42(3): 823-834.
14. 修典荣, 王行雁. 肝门部胆管癌的精准外科诊疗进展. 国际外科学杂志, 2017, 44(7): 433-436.
15. 毛谅, 陈骏, 孙士全, 等. 美国癌症联合委员会肝门部胆管癌分期系统 (第 8 版) 更新解读. 中国实用外科杂志, 2017, 37(5): 510-513.
16. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg, 1992, 215(1): 31-38.
17. 中国抗癌协会. 肝门部胆管癌规范化诊治专家共识 (2015). 中华肝胆外科杂志, 2015, 21(8): 505-511.
18. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg, 2001, 234(4): 507-517.
19. Zaydfudim VM, Clark CJ, Kendrick ML, et al. Correlation of staging systems to survival in patients with resected hilar cholangiocarcinoma. Am J Surg, 2013, 206(2): 159-165.
20. Deoliveira ML, Schulick RD, Nimura Y, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4): 1363-1371.
21. 王杰, 刘厚宝. 肝门部胆管癌术前胆道引流的现状和研究进展. 中华肝胆外科杂志, 2018, 24(1): 59-64.
22. 黄志强. 肝门部胆管癌外科治疗的现状与我见. 中国实用外科杂志, 2007, 27(5): 341-346.
23. Kawakubo K, Kawakami H, Kuwatani M, et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma. World J Gastrointest Endosc, 2016, 8(9): 385-390.
24. Jang SI, Hwang JH, Lee KH, et al. Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors. J Gastroenterol Hepatol, 2017, 32(4): 932-938.
25. Dumitrascu T, Brasoveanu V, Stroescu C, et al. Major hepatectomies for perihilar cholangiocarcinoma: predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions. Asian J Surg, 2016, 39(2): 81-89.
26. Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
27. Marti J, Giacca M, Alshebeeb K, et al. Analysis of preoperative portal vein embolization outcomes in patients with hepatocellular carcinoma: a single-center experience. J Vasc Interv Radiol, 2018, 29(7): 920-926.
28. 杜成友, 肖衡. ALPPS 在原发性肝癌治疗中的价值和评价. 中国普外基础与临床杂志, 2017, 24(12): 1435-1441.
29. 赵帅, 王许安, 刘颖斌. 肝门胆管癌的外科争议及围肝门切除. 肝胆胰外科杂志, 2016, 28(4): 346-350.
30. Robles R, Parrilla P, López-Conesa A, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg, 2014, 101(9): 1129-1134.
31. 张东, 陶杰, 耿智敏, 等. 联合半肝切除肝门部胆管癌 63 例预后分析. 西部医学, 2017, 29(7): 927-930, 934.
32. 董家鸿, 项灿宏, 石军, 等. 以围肝门切除为本的肝门胆管癌治愈性切除的临床分析. 中华消化外科杂志, 2017, 16(10): 1053-1060.
33. 吕少诚, 潘冰, 贺强. 联合肝脏切除术治疗 Bismuth Ⅲb 型肝门部胆管癌的技术要点. 国际外科学杂志, 2017, 44(4): 265-267.
34. 管小青, 顾书成, 吴骥, 等. 联合肝叶及入肝血管切除和重建治疗肝门部胆管癌的临床研究. 中国普外基础与临床杂志, 2015, 22(1): 64-69.
35. 黄庆国, 朱载阳, 李鹏泽. 扩大肝切除术治疗Ⅲ至Ⅳ期肝门胆管癌的临床价值. 癌症进展, 2017, 15(3): 325-327.
36. Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut, 2012, 61(12): 1657-1669.
37. Miyazaki M, Yoshitomi H, Miyakawa S, et al. Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition. J Hepatobiliary Pancreat Sci, 2015, 22(4): 249-273.
38. 中华医学会外科学分会胆道外科学组, 解放军全军肝胆外科专业委员会. 肝门部胆管癌诊断和治疗指南 (2013 版). 中华外科杂志, 2013, 51(10): 865-871.
39. 国际肝胆胰学会中国分会, 中华医学会外科学分会肝胆外科学组. 胆管癌诊断与治疗—外科专家共识. 临床肝胆病杂志, 2015, 31(1): 12-16.
40. Olthof PB, Wiggers JK, Groot Koerkamp B, et al. Postoperative liver failure risk score: identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein emboli- zation. J Am Coll Surg, 2017, 225(3): 387-394.
41. Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg, 2005, 242(3): 451-458.
42. Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma. World J Gastroenterol, 2013, 19(48): 9209-9215.
43. Loveday BPT, Knox JJ, Dawson LA, et al. Neoadjuvant hyperfractionated chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma in Canada. J Surg Oncol, 2018, 117(2): 213-219.
44. Ghiassi-Nejad Z, Tarchi P, Moshier E, et al. Prognostic factors and patterns of locoregional failure after surgical resection in patients with cholangiocarcinoma without adjuvant radiation therapy: optimal field design for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys, 2017, 99(4): 805-811.
45. Krasnick BA, Jin LX, Davidson JT 4^th, et al. Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: a multi-institution analysis from the U. S. extrahepatic biliary malignancy consortium. J Surg Oncol, 2018, 117(3): 363-371.
46. 李志海. 肝门部胆管癌经内镜置入金属支架结合局部放疗疗效分析. 中国实用医药, 2016, 11(4): 66-67.
47. 闫炫炫, 李多富, 李汛. 光动力疗法在不可切除肝门部胆管癌中的应用. 中国普外基础与临床杂志, 2018, 25(4): 488-492.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress in diagnosis and treatment of hilar cholangiocarcinoma

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