Repair of invading inferior vena cava with round ligament of liver for treatment of intrahepatic cholangiocarcinoma: a case of MDT discussion_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jing ^1,2 , JIANG Zebin ^1,2 , MA Bingqiang ^1,2 , YAN Yuke ^1,2 , HOU Yabo ^1,2 , CHAI Naijun ^1,2 , MENG Yun ³ ,  YANG Xiaojun ^1,2

1. The Second Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;
2. Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;
3. Clinical College of Gansu University of Chinese Medicine, Lanzhou 730000, P. R. China;

Corresponding author：

YANG Xiaojun, Email: yangxjmd@aliyun.com

Keywords：

intrahepatic cholangiocarcinoma; multi disciplinary team; diagnosis; treatment

DOI：

10.7507/1007-9424.202204054

Video：

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Objective To summarize the multi disciplinary team (MDT) discussion in the treatment of intrahepatic cholangiocarcinoma (ICC) involving inferior vena cava (IVC). Method The clinical data of a difficult ICC patient diagnosed and treated in Gansu Provincial Hospital in September 2020 were analyzed retrospectively, and the clinical features, diagnosis, treatment decision and prognosis of ICC were summarized. Results The patient was initially diagnosed as liver malignant tumor, which invaded the right adrenal gland and inferior vena cava. After MDT discussion, the patient decided to undergo surgical treatment, and successfully underwent radical resection of liver tumor combined with right adrenal gland and partial inferior vena cava and vascular reconstruction. The operation lasted 300 minutes, and the intraoperative bleeding was about 600 mL. The results of postoperative pathological examination indicated that it conformed to ICC, and carcinomatous tissues involvement could be seen in inferior vena cava and adrenal gland. The patient had no complication after operation and was discharged from hospital at 2 weeks after operation. The patient had been followed up for half a year and had been regularly treated with gemcitabine combined with platinum for 6 phases. No tumor recurrence or metastasis had been found. Conclusions The onset of ICC is concealed and its invasiveness is strong. The preliminary diagnosis can be determined by imaging examination combined with detection of tumor markers. Radical surgery is the main treatment. After MDT discussion, the formulation of a comprehensive treatment plan, including surgical strategy, local treatment and systemic treatment, can improve the prognosis and prolong the survival time of patients.

Citation： LI Jing, JIANG Zebin, MA Bingqiang, YAN Yuke, HOU Yabo, CHAI Naijun, MENG Yun, YANG Xiaojun. Repair of invading inferior vena cava with round ligament of liver for treatment of intrahepatic cholangiocarcinoma: a case of MDT discussion. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1445-1451. doi: 10.7507/1007-9424.202204054 Copy

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2.	Yamamoto Y, Sugiura T, Todaka A, et al. Surgical indication for advanced intrahepatic cholangiocarcinoma according to the optimal preoperative carbohydrate antigen 19-9 cutoff value. World J Surg, 2018, 42(10): 3331-3340.
3.	Cieslak KP, Huisman F, Bais T, et al. Future remnant liver function as predictive factor for the hypertrophy response after portal vein embolization. Surgery, 2017, 162(1): 37-47.
4.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019版). 中华消化外科杂志, 2020, 19(1): 1-20.
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8.	Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol, 2014, 60(6): 1268-1289.
9.	Liau JY, Tsai JH, Yuan RH, et al. Morphological subclassification of intrahepatic cholangiocarcinoma: etiological, clinicopathological, and molecular features. Mod Pathol, 2014, 27(8): 1163-1173.
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12.	陈枫, 赵大伟, 文硕, 等. 肝内肿块型胆管癌的CT、MRI动态增强表现以及与病理分化程度的关系. 中华放射学杂志, 2015, 49(11): 843-847.
13.	邸亮, 曾道炳. 精准医学时代肝内胆管细胞癌诊治进展. 中华肝脏外科手术学电子杂志, 2020, 9(1): 11-16.
14.	Wang JK, Hu HJ, Shrestha A, et al. Can preoperative and postoperative CA19-9 levels predict survival and early recurrence in patients with resectable hilar cholangiocarcinoma? Oncotarget, 2017, 8(28): 45335-45344.
15.	He C, Zhang Y, Song Y, et al. Preoperative CEA levels are supplementary to CA19-9 levels in predicting prognosis in patients with resectable intrahepatic cholangiocarcinoma. J Cancer, 2018, 9(17): 3117-3128.
16.	Dolscheid-Pommerich RC, Manekeller S, Walgenbach-Brünagel G, et al. Clinical performance of CEA, CA19-9, CA15-3, CA125 and AFP in gastrointestinal cancer using LOCI^™-based assays. Anticancer Res, 2017, 37(1): 353-359.
17.	刘国. 利用超声鉴别诊断肝细胞肝癌、肝胆管细胞癌的临床价值. 影像研究与医学应用, 2018, 2(22): 150-151.
18.	张梅, 丁洪彬. 螺旋CT和MRI诊断肝内胆管细胞癌的运用价值分析. 影像技术, 2019, 31(6): 39-42.
19.	Zhao YJ, Chen WX, Wu DS, et al. Differentiation of mass-forming intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma: based on the multivariate analysis of contrast-enhanced computed tomography findings. Abdom Radiol (NY), 2016, 41(5): 978-989.
20.	陈佳妮. 肝内周围型胆管细胞癌的CT及MRI诊断价值对比评价. 影像研究与医学应用, 2018, 2(14): 174-175.
21.	Cho ES, Choi JY. MRI features of hepatocellular carcinoma related to biologic behavior. Korean J Radiol, 2015, 16(3): 449-464.
22.	Kim SY. Preoperative radiologic evaluation of cholangiocarcinoma. Korean J Gastroenterol, 2017, 69(3): 159-163.
23.	Lee Y, Yoo IR, Boo SH, et al. The role of F-18 FDG PET/CT in intrahepatic cholangiocarcinoma. Nucl Med Mol Imaging, 2017, 51(1): 69-78.
24.	Ma KW, Cheung TT, She WH, et al. The effect of wide resection margin in patients with intrahepatic cholangiocarcinoma: A single-center experience. Medicine (Baltimore), 2016, 95(28): e4133. doi: 10.1097/MD.0000000000004133.
25.	Tomimaru Y, Eguchi H, Wada H, et al. Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review. Ann Gastroenterol Surg, 2018, 2(3): 182-186.
26.	中国医师协会肝癌专业委员会. 肝内胆管癌外科治疗中国专家共识(2020版). 中华消化外科杂志, 2021, 20(1): 1-15.
27.	Hoyos S, Navas MC, Restrepo JC, et al. Current controversies in cholangiocarcinoma. Biochim Biophys Acta Mol Basis Dis, 2018, 1864(4 Pt B): 1461-1467.
28.	Brauer DG, Fields RC, Tan BR, et al. Optimal extent of surgical and pathologic lymph node evaluation for resected intrahepatic cholangiocarcinoma. HPB (Oxford), 2018, 20(5): 470-476.
29.	Le Roy B, Gelli M, Pittau G, et al. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Br J Surg, 2018, 105(7): 839-847.
30.	Ma KW, Cheung TT, Leung B, et al. Adjuvant chemotherapy improves oncological outcomes of resectable intrahepatic cholangiocarcinoma: A meta-analysis. Medicine (Baltimore), 2019, 98(5): e14013. doi: 10.1097/MD.0000000000014013.
31.	王超群, 陆录, 钦伦秀. 肝内胆管细胞癌诊疗策略. 中华肝脏外科手术学电子杂志, 2020, 9(1): 1-5.
32.	Goyal L, Saha SK, Liu LY, et al. Polyclonal secondary FGFR2 mutations drive acquired resistance to FGFR inhibition in patients with FGFR2 fusion-positive cholangiocarcinoma. Cancer Discov, 2017, 7(3): 252-263.

1. Sapisochín G, Fernández de Sevilla E, Echeverri J, et al. Liver transplantation for cholangiocarcinoma: Current status and new insights. World J Hepatol, 2015, 7(22): 2396-2403.
2. Yamamoto Y, Sugiura T, Todaka A, et al. Surgical indication for advanced intrahepatic cholangiocarcinoma according to the optimal preoperative carbohydrate antigen 19-9 cutoff value. World J Surg, 2018, 42(10): 3331-3340.
3. Cieslak KP, Huisman F, Bais T, et al. Future remnant liver function as predictive factor for the hypertrophy response after portal vein embolization. Surgery, 2017, 162(1): 37-47.
4. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019版). 中华消化外科杂志, 2020, 19(1): 1-20.
5. National Comprehensive Cancer Network (NCCN). ClinicalPractice Guidelines in Oncology. Hepatobiliary Cancers, Version 5.2020-08-04. https://www.nccn.org/professionals/ physician_gls/pdf/hepatobiliary.pdf.
6. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
7. Yeesoonsang S, McNeil E, Virani S, et al. Trends in incidence of two major subtypes of liver and bile duct cancer: hepatocellular carcinoma and cholangiocarcinoma in Songkhla, Southern Thailand, 1989-2030. J Cancer Epidemiol, 2018, 2018: 8267059. doi: 10.1155/2018/8267059.
8. Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol, 2014, 60(6): 1268-1289.
9. Liau JY, Tsai JH, Yuan RH, et al. Morphological subclassification of intrahepatic cholangiocarcinoma: etiological, clinicopathological, and molecular features. Mod Pathol, 2014, 27(8): 1163-1173.
10. Zhang XF, Chakedis J, Bagante F, et al. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. Br J Surg, 2018, 105(7): 857-866.
11. Weber SM, Ribero D, O’Reilly EM, et al. Intrahepatic cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
12. 陈枫, 赵大伟, 文硕, 等. 肝内肿块型胆管癌的CT、MRI动态增强表现以及与病理分化程度的关系. 中华放射学杂志, 2015, 49(11): 843-847.
13. 邸亮, 曾道炳. 精准医学时代肝内胆管细胞癌诊治进展. 中华肝脏外科手术学电子杂志, 2020, 9(1): 11-16.
14. Wang JK, Hu HJ, Shrestha A, et al. Can preoperative and postoperative CA19-9 levels predict survival and early recurrence in patients with resectable hilar cholangiocarcinoma? Oncotarget, 2017, 8(28): 45335-45344.
15. He C, Zhang Y, Song Y, et al. Preoperative CEA levels are supplementary to CA19-9 levels in predicting prognosis in patients with resectable intrahepatic cholangiocarcinoma. J Cancer, 2018, 9(17): 3117-3128.
16. Dolscheid-Pommerich RC, Manekeller S, Walgenbach-Brünagel G, et al. Clinical performance of CEA, CA19-9, CA15-3, CA125 and AFP in gastrointestinal cancer using LOCI^™-based assays. Anticancer Res, 2017, 37(1): 353-359.
17. 刘国. 利用超声鉴别诊断肝细胞肝癌、肝胆管细胞癌的临床价值. 影像研究与医学应用, 2018, 2(22): 150-151.
18. 张梅, 丁洪彬. 螺旋CT和MRI诊断肝内胆管细胞癌的运用价值分析. 影像技术, 2019, 31(6): 39-42.
19. Zhao YJ, Chen WX, Wu DS, et al. Differentiation of mass-forming intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma: based on the multivariate analysis of contrast-enhanced computed tomography findings. Abdom Radiol (NY), 2016, 41(5): 978-989.
20. 陈佳妮. 肝内周围型胆管细胞癌的CT及MRI诊断价值对比评价. 影像研究与医学应用, 2018, 2(14): 174-175.
21. Cho ES, Choi JY. MRI features of hepatocellular carcinoma related to biologic behavior. Korean J Radiol, 2015, 16(3): 449-464.
22. Kim SY. Preoperative radiologic evaluation of cholangiocarcinoma. Korean J Gastroenterol, 2017, 69(3): 159-163.
23. Lee Y, Yoo IR, Boo SH, et al. The role of F-18 FDG PET/CT in intrahepatic cholangiocarcinoma. Nucl Med Mol Imaging, 2017, 51(1): 69-78.
24. Ma KW, Cheung TT, She WH, et al. The effect of wide resection margin in patients with intrahepatic cholangiocarcinoma: A single-center experience. Medicine (Baltimore), 2016, 95(28): e4133. doi: 10.1097/MD.0000000000004133.
25. Tomimaru Y, Eguchi H, Wada H, et al. Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review. Ann Gastroenterol Surg, 2018, 2(3): 182-186.
26. 中国医师协会肝癌专业委员会. 肝内胆管癌外科治疗中国专家共识(2020版). 中华消化外科杂志, 2021, 20(1): 1-15.
27. Hoyos S, Navas MC, Restrepo JC, et al. Current controversies in cholangiocarcinoma. Biochim Biophys Acta Mol Basis Dis, 2018, 1864(4 Pt B): 1461-1467.
28. Brauer DG, Fields RC, Tan BR, et al. Optimal extent of surgical and pathologic lymph node evaluation for resected intrahepatic cholangiocarcinoma. HPB (Oxford), 2018, 20(5): 470-476.
29. Le Roy B, Gelli M, Pittau G, et al. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Br J Surg, 2018, 105(7): 839-847.
30. Ma KW, Cheung TT, Leung B, et al. Adjuvant chemotherapy improves oncological outcomes of resectable intrahepatic cholangiocarcinoma: A meta-analysis. Medicine (Baltimore), 2019, 98(5): e14013. doi: 10.1097/MD.0000000000014013.
31. 王超群, 陆录, 钦伦秀. 肝内胆管细胞癌诊疗策略. 中华肝脏外科手术学电子杂志, 2020, 9(1): 1-5.
32. Goyal L, Saha SK, Liu LY, et al. Polyclonal secondary FGFR2 mutations drive acquired resistance to FGFR inhibition in patients with FGFR2 fusion-positive cholangiocarcinoma. Cancer Discov, 2017, 7(3): 252-263.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Repair of invading inferior vena cava with round ligament of liver for treatment of intrahepatic cholangiocarcinoma: a case of MDT discussion

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