Surgical strategy for bile duct cancer: Advances and current limitations
- 1 January 2011
- journal article
- Published by Baishideng Publishing Group Inc. in World Journal of Clinical Oncology
- Vol. 2 (2), 94-107
- https://doi.org/10.5306/wjco.v2.i2.94
Abstract
The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer. Radical resection with a microscopically negative margin (R0) is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections. Complete resection of the tumor is the surgeon's ultimate aim, and several advances in the surgical treatment for bile duct cancer have been made within the last two decades. Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer, in terms of both longitudinal and vertical tumor invasion. Many meticulous operative procedures have been established, especially extended hepatectomy for hilar cholangiocarcinoma, to achieve a negative resection margin, which is the only prognostic factor under the control of the surgeon. A complete caudate lobectomy and resection of the inferior part of Couinaud's segment IV coupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma, and pylorus-preserving pancreaticoduodenectomy is the first choice for distal bile duct cancer. Limited resection for middle bile duct cancer is indicated for only strictly selected cases. Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients, especially jaundiced patients anticipating major hepatectomy. Liver transplantation seems ideal for complete resection of bile duct cancer, but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment. Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence, but no definite regimen has been established to date. Further evidence is needed to fully define the role of liver transplantation and adjuvant chemo-radiotherapy.This publication has 100 references indexed in Scilit:
- A randomised phase II trial of weekly high-dose 5-fluorouracil with and without folinic acid and cisplatin in patients with advanced biliary tract carcinoma: results of the 40955 EORTC trialEuropean Journal of Cancer, 2005
- Hepatectomy With Portal Vein Resection for Hilar CholangiocarcinomaAnnals of Surgery, 2003
- Results of Surgical Resection for Patients With Hilar Bile Duct CancerAnnals of Surgery, 2003
- Incidence of benign lesions in patients resected for suspicious hilar obstructionBritish Journal of Surgery, 2001
- Effects of 5-Fluorouracil and Leucovorin in the Treatment of Pancreatic–Biliary Tract AdenocarcinomasAmerican Journal of Clinical Oncology, 2000
- One hundred and eleven liver resections for hilar bile duct cancerJournal of Hepato-Biliary-Pancreatic Surgery, 2000
- Biliary Tract CancersThe New England Journal of Medicine, 1999
- Outcome of treatment for distal bile duct cancerBritish Journal of Surgery, 1996
- Factors Influencing Postoperative Morbidity, Mortality, and Survival After Resection for Hilar CholangiocarcinomaAnnals of Surgery, 1996
- Epirubicin, cisplatin and infusional 5-fluorouracil (5-FU) (ECF) in hepatobiliary tumoursEuropean Journal of Cancer, 1995