Multidisciplinary management of intrahepatic cholangiocarcinoma: Current approaches
Multidisciplinary management of intrahepatic cholangiocarcinoma: Current approaches
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DOI：
10.1016/j.suronc.2017.03.001
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发表时间：
2017-06-01
影响因子：
2.3
通讯作者：
Han, Ho-Seong
中科院分区：
文献类型：
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作者：
Guro, Hanisah;Kim, Jin Won;Han, Ho-Seong
肝内胆管癌是一种常见的原发性肝脏肿瘤。然而，由于其非特异性表现和晚期检测，其结果通常比肝细胞癌差。最广泛使用的血清标志物碳水化合物抗原19-9是非特异性的。此外，影像学研究很少发现任何病理特征。手术是提供长期生存机会的唯一治疗选择。然而，由于肝内转移、腹膜癌或肝外转移的高频率，可切除率很低。应根据ICC的宏观分类（如肿块形成、管周浸润、管内生长类型）来调整手术治疗，因为它反映了肿瘤的播散方式。虽然淋巴结转移是一个不良预后因素，但淋巴结清扫的重要性和程度仍存在争议。为了提高患者的生存率，一些不可切除的ICC患者考虑肝移植，特别是那些残肝容量不足的患者。微创手术，包括腹腔镜和机器人肝切除术，已经经过测试，并在初步研究中取得了与传统手术相当的结果。没有随机试验证实辅助化疗对ICC的疗效，一些试验评估了分子靶向药物作为单一治疗或与细胞毒性化疗联合使用。多学科的方法是必要的，以提高国际商会的结果。(C) 2017 Elsevier Ltd.版权所有。
Intrahepatic cholangiocarcinoma (ICC) is a common primary hepatic tumor. However, its outcomes are usually worse than those of hepatocellular carcinoma owing to its non-specific presentation and detection at an advanced stage. The most widely used serum marker, carbohydrate antigen 19-9, is nonspecific. Furthermore, imaging studies rarely identify any pathognomonic features. Surgery is the only treatment option that offers a chance of long-term survival. However, the resectability rate is low owing to the high frequencies of intrahepatic metastases, peritoneal carcinomatosis, or extrahepatic metastases. Surgical treatment should be tailored according to the macroscopic classification of ICC (e.g. massforming, periductal infiltrating, and intraductal growth types) because it reflects the tumor's dissemination pattern. Although lymph node metastasis is a negative prognostic factor, the importance and extent of lymph node dissection is still controversial. To improve patient survival, liver transplantation is considered in some patients with unresectable ICC, especially in those with an insufficient remnant liver volume. Minimally invasive procedures, including laparoscopic and robotic liver resection, have been tested and achieved comparable outcomes to conventional surgery in preliminary studies. No randomized trials have confirmed the efficacy of adjuvant chemotherapy in ICC, and several trials have evaluated molecular-targeted agents as monotherapy or in combination with cytotoxic chemotherapy. Multidisciplinary approaches are necessary to improve the outcomes of ICC. (C) 2017 Elsevier Ltd. All rights reserved.