Vascular Resection in Perihilar Cholangiocarcinoma.
Vascular Resection in Perihilar Cholangiocarcinoma.
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DOI：
10.3390/cancers13215278
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发表时间：
2021-10-21
期刊：
影响因子：
5.2
通讯作者：
Tejedor L
中科院分区：
文献类型：
--
作者：
Serrablo A;Serrablo L;Alikhanov R;Tejedor L
在肝门周围胆管癌血管受累，血管切除，以实现无边缘状态正在进行越来越多的频率，尽管有争议的结果。发病率、死亡率和总生存率在世界各地差异很大。血管切除术可包括单独的门静脉切除术、单独的肝动脉切除术或联合切除术。在某些局部晚期疾病的情况下，可以进行扩大切除术，如肝胰腺切除术或肝移植，以达到R0状态或治愈的变化。新辅助治疗可以帮助实现这一目标。本文回顾并更新了在这种情况下的所有治疗方案。在胆管癌中，最常见的类型是肝门周围型（phCC），约占病例的60%，其次是远端型和肝内型。目前还没有一个分期系统，可以对所有系列进行比较，并得出结论，增加这种令人沮丧的疾病的长期生存率。切除范围的扩大在理论上取决于原发性肝癌的类型，这不是一个封闭的课题。由于手术是唯一已知的治愈方法，因此采用了许多积极的方法。尽管进行了扩大的肝切除，甚至血管切除，但约三分之一的患者切缘阳性。在过去的二十年里，随着诊断和手术技术的进步，手术结局和生存率逐渐提高，尽管变异性是规律，发病率和死亡率分别为14%至76%和0%至19%。左侧肿瘤常需行扩大肝切除、门静脉切除，甚至肝右动脉重建。当动脉重建不可行时的补救手术以及肝胰腺切除术也仍在评估中。在这篇文章中，我们讨论了积极的手术方法，以肝细胞癌血管切除为重点。不同的结果对phCC的手术治疗使得它不可能达到明确的结论。
In perihilar cholangiocarcinoma with vascular involvement, vascular resection to achieve margin-free status is being performed with increasing frequency despite controversial results. Morbidity, mortality, and overall survival are widely variable throughout the world. Vascular resections can include the portal vein alone, the hepatic artery alone, or combined resections. In some cases of locally advance disease, extended resections, such as hepatopancreatoduodenectomy or liver transplant, may be performed to achieve R0 status or a change to cure. The neoadjuvant treatment could help to achieve it. This article reviews and updates all treatment options in this setting. Among the cholangiocarcinomas, the most common type is perihilar (phCC), accounting for approximately 60% of cases, after which are the distal and then intrahepatic forms. There is no staging system that allows for a comparison of all series and extraction of conclusions that increase the long-term survival rate of this dismal disease. The extension of the resection, which theoretically depends on the type of phCC, is not a closed subject. As surgery is the only known way to achieve a cure, many aggressive approaches have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection, or even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.