Current situation and prospect of surgical treatment of hilar cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jialong ,  SHAO Yingmei

Department of Hepatobiliary Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding author：

SHAO Yingmei, Email: syingmei1@163.com

Keywords：

hilar cholangiocarcinoma; surgical treatment; review

DOI：

10.7507/1007-9424.202205016

Video：

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Objective To understand the current situation of surgical treatment of hilar cholangiocarcinoma. Method The literature relevant to surgical treatment of hilar cholangiocarcinoma at home and abroad in recent years was reviewed. Results The various surgical treatment schemes of hilar cholangiocarcinoma had advantages and disadvantages. At present, there were still disputes and no unified consensus on preoperative preparation, selection of intraoperative surgical resection range, and applications of laparoscopy and robot, etc. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. Conclusion It is believed that accurate preoperative condition evaluation should be carried out for each patient with hilar cholangiocarcinoma, so as to formulate the best surgical treatment plan, achieve individualized accurate treatment and benefit patients.

Citation： LI Jialong, SHAO Yingmei. Current situation and prospect of surgical treatment of hilar cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1528-1533. doi: 10.7507/1007-9424.202205016 Copy

1.	Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med, 1965, 38: 241-256.
2.	Elvevi A, Laffusa A, Scaravaglio M, et al. Clinical treatment of cholangiocarcinoma: an updated comprehensive review. Ann Hepatol. 2022 Jul 6: 100737. doi: 10.1016/j.aohep.2022.100737.
3.	陈孝平, 项帅. 精准医学时代肝门部胆管癌的治疗. 中华消化外科杂志, 2018, 17(1): 3-8.
4.	Inchingolo R, Acquafredda F, Ferraro V, et al. Non-surgical treatment of hilar cholangiocarcinoma. World J Gastrointest Oncol, 2021, 13(11): 1696-1708.
5.	Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
6.	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.
7.	van Keulen AM, Olthof PB, Cescon M, et al. Actual 10-year survival after resection of perihilar cholangiocarcinoma: what factors preclude a chance for cure? Cancers (Basel), 2021, 13(24): 6260. doi: 10.3390/cancers13246260.
8.	Mocan T, Horhat A, Mois E, et al. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: when and how? World J Gastrointest Oncol, 2021, 13(12): 2050-2063.
9.	Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery, 1990, 107(5): 521-527.
10.	Li PP, Huang G, Jia NY, et al. Associating liver partition and portal vein ligation for staged hepatectomy versus sequential transarterial chemoembolization and portal vein embolization in staged hepatectomy for HBV-related hepatocellular carcinoma: a randomized comparative study. Hepatobiliary Surg Nutr, 2022, 11(1): 38-51.
11.	Benson AB, D’Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(5): 541-565.
12.	Higuchi R, Yamamoto M. Indications for portal vein embolization in perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2014, 21(8): 542-549.
13.	Capobianco I, Oldhafer KJ, Fard-Aghaie MH, et al. Development and internal validation of the comprehensive ALPPS preoperative risk assessment (CAPRA) score: is the patient suitable for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)? Hepatobiliary Surg Nutr, 2022, 11(1): 52-66.
14.	Qin Y, Li C, Ge X, et al. MMP2/9 downregulation is responsible for hepatic function recovery in cirrhotic rats following associating liver partition and portal vein ligation for staged hepatectomy. Ann Transl Med, 2022, 10(8): 468. doi: 10.21037/atm-22-1312.
15.	Berardi G, Guglielmo N, Colasanti M, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for advanced hepatocellular carcinoma with macrovascular invasion. Updates Surg, 2022, 74(3): 927-936.
16.	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.
17.	Xu X, Yang L, Chen W, et al. Transhepatic hilar approach for Bismuth types Ⅲ and Ⅳ perihilar cholangiocarcinoma with long-term outcomes. J Int Med Res, 2021, 49(5): 3000605211008336. doi: 10.1177/03000605211008336.
18.	孟翔飞, 董家鸿, 黄志强. 围肝门部胆管临床解剖学研究进展. 中华外科杂志, 2010, 48(13): 1022-1026.
19.	陈孝平, 黄志勇, 陈义发, 等. 肝门部胆管癌根治术肝切除范围的合理选择. 中国普通外科杂志, 2013, 22(1): 8-9.
20.	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.
21.	董家鸿, 项灿宏, 石军, 等. 以围肝门切除为本的肝门部胆管癌治愈性切除术的临床疗效. 中华消化外科杂志, 2017, 16(10): 1053-1060.
22.	Hosokawa I, Furukawa K, Takayashiki T, et al. Surgical implications of the confluence patterns of the left intrahepatic bile ducts in right hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci, 2022, 29(4): 460-468.
23.	Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg, 1990, 14(4): 535-543.
24.	Gaspersz MP, Buettner S, van Vugt JLA, et al. Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for perihilar cholangiocarcinoma. J Gastrointest Surg, 2020, 24(7): 1612-1618.
25.	Sugiura T, Uesaka K, Okamura Y, et al. Major hepatectomy with combined vascular resection for perihilar cholangiocarcinoma. BJS Open, 2021, 5(4): zrab064. doi: 10.1093/bjsopen/zrab064.
26.	Rebelo A, Friedrichs J, Grilli M, et al. Systematic review and meta-analysis of surgery for hilar cholangiocarcinoma with arterial resection. HPB (Oxford), 2022: S1365-182X(22)00097-1. doi: 10.1016/j.hpb.2022.04.002.
27.	Yu H, Wu SD, Chen DX, et al. Laparoscopic resection of Bismuth type Ⅰ and Ⅱ hilar cholangiocarcinoma: an audit of 14 cases from two institutions. Dig Surg, 2011, 28(1): 44-49.
28.	Ma D, Wang W, Wang J, et al. Laparoscopic versus open surgery for hilar cholangiocarcinoma: a retrospective cohort study on short-term and long-term outcomes. Surg Endosc, 2022, 36(6): 3721-3731.
29.	van der Poel MJ, Fichtinger RS, Bemelmans M, et al. Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands. HPB (Oxford), 2019, 21(12): 1734-1743.
30.	Ban D, Tanabe M, Kumamaru H, et al. Safe dissemination of laparoscopic liver resection in 27 146 cases between 2011 and 2017 from the National Clinical Database of Japan. Ann Surg, 2021, 274(6): 1043-1050.
31.	Xiong Y, Jingdong L, Zhaohui T, et al. A consensus meeting on expert recommendations on operating specifications for laparoscopic radical resection of hilar cholangiocarcinoma. Front Surg, 2021, 8: 731448. doi: 10.3389/fsurg.2021.731448.
32.	Sucandy I, Ross S, Rosemurgy A. Robotic resection of a type ⅢB Klatskin tumor. J Gastrointest Surg, 2021, 25(7): 1939-1940.
33.	Cipriani F, Fiorentini G, Magistri P, et al. Pure laparoscopic versus robotic liver resections: multicentric propensity score-based analysis with stratification according to difficulty scores. J Hepatobiliary Pancreat Sci, 2021 Jul 22. doi: 10.1002/jhbp.1022.
34.	Lauterio A, De Carlis R, Centonze L, et al. Current surgical management of peri-hilar and intra-hepatic cholangiocarcinoma. Cancers (Basel), 2021, 13(15): 3657. doi: 10.3390/cancers13153657.
35.	Hand F, Hoti E. Contemporary role of liver transplantation for the treatment of cholangiocarcinoma. Expert Rev Gastroenterol Hepatol, 2020, 14(6): 475-481.
36.	Chen P, Yang T, Shi P, et al. Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: a meta-analysis. Photodiagnosis Photodyn Ther, 2022, 37: 102712. doi: 10.1016/j.pdpdt.2022.102712.
37.	Li Z, Jiang X, Xiao H, et al. Long-term results of ERCP- or PTCS-directed photodynamic therapy for unresectable hilar cholangiocarcinoma. Surg Endosc, 2021, 35(10): 5655-5664.
38.	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.
39.	Shramova EI, Chumakov SP, Shipunova VO, et al. Genetically encoded BRET-activated photodynamic therapy for the treatment of deep-seated tumors. Light Sci Appl, 2022, 11(1): 38. doi: 10.1038/s41377-022-00729-4.

1. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med, 1965, 38: 241-256.
2. Elvevi A, Laffusa A, Scaravaglio M, et al. Clinical treatment of cholangiocarcinoma: an updated comprehensive review. Ann Hepatol. 2022 Jul 6: 100737. doi: 10.1016/j.aohep.2022.100737.
3. 陈孝平, 项帅. 精准医学时代肝门部胆管癌的治疗. 中华消化外科杂志, 2018, 17(1): 3-8.
4. Inchingolo R, Acquafredda F, Ferraro V, et al. Non-surgical treatment of hilar cholangiocarcinoma. World J Gastrointest Oncol, 2021, 13(11): 1696-1708.
5. Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
6. 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.
7. van Keulen AM, Olthof PB, Cescon M, et al. Actual 10-year survival after resection of perihilar cholangiocarcinoma: what factors preclude a chance for cure? Cancers (Basel), 2021, 13(24): 6260. doi: 10.3390/cancers13246260.
8. Mocan T, Horhat A, Mois E, et al. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: when and how? World J Gastrointest Oncol, 2021, 13(12): 2050-2063.
9. Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery, 1990, 107(5): 521-527.
10. Li PP, Huang G, Jia NY, et al. Associating liver partition and portal vein ligation for staged hepatectomy versus sequential transarterial chemoembolization and portal vein embolization in staged hepatectomy for HBV-related hepatocellular carcinoma: a randomized comparative study. Hepatobiliary Surg Nutr, 2022, 11(1): 38-51.
11. Benson AB, D’Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(5): 541-565.
12. Higuchi R, Yamamoto M. Indications for portal vein embolization in perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2014, 21(8): 542-549.
13. Capobianco I, Oldhafer KJ, Fard-Aghaie MH, et al. Development and internal validation of the comprehensive ALPPS preoperative risk assessment (CAPRA) score: is the patient suitable for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)? Hepatobiliary Surg Nutr, 2022, 11(1): 52-66.
14. Qin Y, Li C, Ge X, et al. MMP2/9 downregulation is responsible for hepatic function recovery in cirrhotic rats following associating liver partition and portal vein ligation for staged hepatectomy. Ann Transl Med, 2022, 10(8): 468. doi: 10.21037/atm-22-1312.
15. Berardi G, Guglielmo N, Colasanti M, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for advanced hepatocellular carcinoma with macrovascular invasion. Updates Surg, 2022, 74(3): 927-936.
16. 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.
17. Xu X, Yang L, Chen W, et al. Transhepatic hilar approach for Bismuth types Ⅲ and Ⅳ perihilar cholangiocarcinoma with long-term outcomes. J Int Med Res, 2021, 49(5): 3000605211008336. doi: 10.1177/03000605211008336.
18. 孟翔飞, 董家鸿, 黄志强. 围肝门部胆管临床解剖学研究进展. 中华外科杂志, 2010, 48(13): 1022-1026.
19. 陈孝平, 黄志勇, 陈义发, 等. 肝门部胆管癌根治术肝切除范围的合理选择. 中国普通外科杂志, 2013, 22(1): 8-9.
20. 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.
21. 董家鸿, 项灿宏, 石军, 等. 以围肝门切除为本的肝门部胆管癌治愈性切除术的临床疗效. 中华消化外科杂志, 2017, 16(10): 1053-1060.
22. Hosokawa I, Furukawa K, Takayashiki T, et al. Surgical implications of the confluence patterns of the left intrahepatic bile ducts in right hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci, 2022, 29(4): 460-468.
23. Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg, 1990, 14(4): 535-543.
24. Gaspersz MP, Buettner S, van Vugt JLA, et al. Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for perihilar cholangiocarcinoma. J Gastrointest Surg, 2020, 24(7): 1612-1618.
25. Sugiura T, Uesaka K, Okamura Y, et al. Major hepatectomy with combined vascular resection for perihilar cholangiocarcinoma. BJS Open, 2021, 5(4): zrab064. doi: 10.1093/bjsopen/zrab064.
26. Rebelo A, Friedrichs J, Grilli M, et al. Systematic review and meta-analysis of surgery for hilar cholangiocarcinoma with arterial resection. HPB (Oxford), 2022: S1365-182X(22)00097-1. doi: 10.1016/j.hpb.2022.04.002.
27. Yu H, Wu SD, Chen DX, et al. Laparoscopic resection of Bismuth type Ⅰ and Ⅱ hilar cholangiocarcinoma: an audit of 14 cases from two institutions. Dig Surg, 2011, 28(1): 44-49.
28. Ma D, Wang W, Wang J, et al. Laparoscopic versus open surgery for hilar cholangiocarcinoma: a retrospective cohort study on short-term and long-term outcomes. Surg Endosc, 2022, 36(6): 3721-3731.
29. van der Poel MJ, Fichtinger RS, Bemelmans M, et al. Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands. HPB (Oxford), 2019, 21(12): 1734-1743.
30. Ban D, Tanabe M, Kumamaru H, et al. Safe dissemination of laparoscopic liver resection in 27 146 cases between 2011 and 2017 from the National Clinical Database of Japan. Ann Surg, 2021, 274(6): 1043-1050.
31. Xiong Y, Jingdong L, Zhaohui T, et al. A consensus meeting on expert recommendations on operating specifications for laparoscopic radical resection of hilar cholangiocarcinoma. Front Surg, 2021, 8: 731448. doi: 10.3389/fsurg.2021.731448.
32. Sucandy I, Ross S, Rosemurgy A. Robotic resection of a type ⅢB Klatskin tumor. J Gastrointest Surg, 2021, 25(7): 1939-1940.
33. Cipriani F, Fiorentini G, Magistri P, et al. Pure laparoscopic versus robotic liver resections: multicentric propensity score-based analysis with stratification according to difficulty scores. J Hepatobiliary Pancreat Sci, 2021 Jul 22. doi: 10.1002/jhbp.1022.
34. Lauterio A, De Carlis R, Centonze L, et al. Current surgical management of peri-hilar and intra-hepatic cholangiocarcinoma. Cancers (Basel), 2021, 13(15): 3657. doi: 10.3390/cancers13153657.
35. Hand F, Hoti E. Contemporary role of liver transplantation for the treatment of cholangiocarcinoma. Expert Rev Gastroenterol Hepatol, 2020, 14(6): 475-481.
36. Chen P, Yang T, Shi P, et al. Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: a meta-analysis. Photodiagnosis Photodyn Ther, 2022, 37: 102712. doi: 10.1016/j.pdpdt.2022.102712.
37. Li Z, Jiang X, Xiao H, et al. Long-term results of ERCP- or PTCS-directed photodynamic therapy for unresectable hilar cholangiocarcinoma. Surg Endosc, 2021, 35(10): 5655-5664.
38. 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.
39. Shramova EI, Chumakov SP, Shipunova VO, et al. Genetically encoded BRET-activated photodynamic therapy for the treatment of deep-seated tumors. Light Sci Appl, 2022, 11(1): 38. doi: 10.1038/s41377-022-00729-4.

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Current situation and prospect of surgical treatment of hilar cholangiocarcinoma

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