Hilar Cholangiocarcinoma: A Review and Commentary

  title={Hilar Cholangiocarcinoma: A Review and Commentary},
  author={Ronald S Chamberlain and Leslie H. Blumgart},
  journal={Annals of Surgical Oncology},
Hilar cholangiocarcinoma is an uncommon cause of malignant biliary obstruction marked by local tumor spread for which surgery offers the only chance of cure. The diagnostic evaluation and surgical management of this disease continues to evolve. Although direct cholangiography and endoscopic biliary procedures have been used extensively to anatomically define the extent of tumor involvement, establish biliary decompression, and obtain histological confirmation of tumor, reliance on these… 

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Multidisciplinary management of perihilar bile duct cancer.

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Because obstructive jaundice is the most common clinical presentation of malignant HBO, endoscopic biliary drainage, when indicated, is the preferred treatment over the percutaneous approach.

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Surgical resection of the tumor together with biliary decompression using different approaches of hepaticojejunostomy is an effective way of managing malignant Hilar bile duct obstruction as well as significantly decreasing the severity of symptoms in irresectable tumours.



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The T-staging system correlates with resectability, the need for hepatectomy, and overall survival, and in half the patients, unresectability is mainly the result of intraabdominal metastases.

Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver.

It is important to expand the indications for resection of tumors of the hilas, generally requiring associated hepatectomy, after careful search for metastases and biopsy of any suspicious areas

Improvements in Survival by Aggressive Resections of Hilar Cholangiocarcinoma

A combination of careful patient selection and complete radiologic assessment will allow an increased proportion of patients to be resected by complex operative procedures with low mortality rate, acceptable morbidity rate, and an increase in survival with an improved quality of life.

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Management is based on a number of factors, including age of the patient, performance status, other comorbid conditions, location of the tumor, and tumor resectability, including complete surgical resection in patients with cholangiocarcinoma.

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The relative merits of the newer methods of radiologic stenting are encouraging, but further study will require prospective trials in comparison to operative biliary enteric bypass.

Management strategies in resection for hilar cholangiocarcinoma.

Improved survival in hilar cholangiocarcinoma can be achieved by resection, with minimal morbidity and zero mortality rates, if histologically free resection margins are obtained.

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