Progress in diagnosis and treatment of hilar cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENG Pengrui ,  SU Yang

Department of Hepatobiliary and Splenic Surgery, The Affiliated Shengjing Hospital of China Medical University, Shenyang 110001, P. R. China;

Corresponding?author：

SU Yang, Email: suyang_1973@163.com

Keywords：

hilar cholangiocarcinoma; diagnosis; preoperative evaluation; treatment; review

DOI：

10.7507/1007-9424.201804058

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the progress in diagnosis and treatment of hilar cholangiocarcinoma at present. Methods The literatures about diagnosis and treatment of hilar cholangiocarcinoma at home and aboard were collected to make an review. Results The diagnosis of hilar cholangiocarcinoma mainly depended on serum tumor molecular markers and imaging examinations. Preoperative excision and prognostic evaluation were required, including tumor classification and staging, preoperative yellow reduction, residual liver volume assessment, and so on. Radical resection was the first choice, as well as liver transplantation, radiotherapy, chemotherapy, and photodynamic therapy could be selected according to the patient’s condition. Conclusions The appearance of new diagnosis and treatment technology promotes the clinical development of hilar cholangiocarcinoma. The integrated diagnosis and treatment mode, which is based on surgery, will become the inevitable direction of the development of hilar cholangiocarcinoma.

Citation： CHENG Pengrui, SU Yang. Progress in diagnosis and treatment of hilar cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1398-1402. doi: 10.7507/1007-9424.201804058 Copy

1.	李斌, 張柏和, 姜小清. 解讀不同指南與共識的熱點及分歧、重視肝門部膽管癌的規范化診療. 中國普外基礎與臨床雜志, 2016, 23(11): 1293-1298.
2.	Berardi R, Mocchegiani F, Pierantoni C, et al. Resected biliary tract cancers: a novel clinical-pathological score correlates with global outcome. Dig Liver Dis, 2013, 45(1): 70-74.
3.	蘇德望, 付先東, 于佳楠, 等. 血清糖類抗原 19-9、癌胚抗原在膽管癌診斷中的應用價值. 中國實驗診斷學, 2017, 21(10): 1693-1695.
4.	Chen P, Li B, Zhu Y, et al. Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma. Oncotarget, 2016, 7(24): 37319-37330.
5.	Lederer A, Herrmann P, Seehofer D, et al. Metastasis-associated in colon cancer 1 is an independent prognostic biomarker for survival in Klatskin tumor patients. Hepatology, 2015, 62(3): 841-850.
6.	陳雄飛, 周寧新, 張紅紅. FXYD6 在肝門膽管癌中的表達及臨床意義. 中國普外基礎與臨床雜志, 2016, 23(11): 1344-1347.
7.	Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: recent advances and challenges. Radiology, 2018, 288(1): 7-13.
8.	Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
9.	倪其泓, 張赟和, 何敏, 等. 多排螺旋 CT 三維重建技術在肝門部膽管癌術前可切除性評估與手術規劃中的應用. 中華肝膽外科雜志, 2016, 22(7): 489-490.
10.	林科燦, 曾永毅, 黎蘊通, 等. 三維重建虛擬手術規劃在肝門部膽管癌手術中的應用價值. 中華消化外科雜志, 2018, 17(4): 383-388.
11.	張成軍. 常規磁共振成像聯合磁共振胰膽管成像對肝門部膽管癌的診斷價值. 新鄉醫學院學報, 2018, 35(3): 235-238.
12.	Lee DH, Lee JM, Hur BY, et al. Colorectal cancer liver metastases: diagnostic performance and prognostic value of PET/MR imaging. Radiology, 2016, 280(3): 782-792.
13.	Ma KW, Cheung TT, She WH, et al. Diagnostic and prognostic role of 18-FDG PET/CT in the management of resectable biliary tract cancer. World J Surg, 2018, 42(3): 823-834.
14.	修典榮, 王行雁. 肝門部膽管癌的精準外科診療進展. 國際外科學雜志, 2017, 44(7): 433-436.
15.	毛諒, 陳駿, 孫士全, 等. 美國癌癥聯合委員會肝門部膽管癌分期系統 (第 8 版) 更新解讀. 中國實用外科雜志, 2017, 37(5): 510-513.
16.	Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg, 1992, 215(1): 31-38.
17.	中國抗癌協會. 肝門部膽管癌規范化診治專家共識 (2015). 中華肝膽外科雜志, 2015, 21(8): 505-511.
18.	Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg, 2001, 234(4): 507-517.
19.	Zaydfudim VM, Clark CJ, Kendrick ML, et al. Correlation of staging systems to survival in patients with resected hilar cholangiocarcinoma. Am J Surg, 2013, 206(2): 159-165.
20.	Deoliveira ML, Schulick RD, Nimura Y, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4): 1363-1371.
21.	王杰, 劉厚寶. 肝門部膽管癌術前膽道引流的現狀和研究進展. 中華肝膽外科雜志, 2018, 24(1): 59-64.
22.	黃志強. 肝門部膽管癌外科治療的現狀與我見. 中國實用外科雜志, 2007, 27(5): 341-346.
23.	Kawakubo K, Kawakami H, Kuwatani M, et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma. World J Gastrointest Endosc, 2016, 8(9): 385-390.
24.	Jang SI, Hwang JH, Lee KH, et al. Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors. J Gastroenterol Hepatol, 2017, 32(4): 932-938.
25.	Dumitrascu T, Brasoveanu V, Stroescu C, et al. Major hepatectomies for perihilar cholangiocarcinoma: predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions. Asian J Surg, 2016, 39(2): 81-89.
26.	Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
27.	Marti J, Giacca M, Alshebeeb K, et al. Analysis of preoperative portal vein embolization outcomes in patients with hepatocellular carcinoma: a single-center experience. J Vasc Interv Radiol, 2018, 29(7): 920-926.
28.	杜成友, 肖衡. ALPPS 在原發性肝癌治療中的價值和評價. 中國普外基礎與臨床雜志, 2017, 24(12): 1435-1441.
29.	趙帥, 王許安, 劉穎斌. 肝門膽管癌的外科爭議及圍肝門切除. 肝膽胰外科雜志, 2016, 28(4): 346-350.
30.	Robles R, Parrilla P, López-Conesa A, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg, 2014, 101(9): 1129-1134.
31.	張東, 陶杰, 耿智敏, 等. 聯合半肝切除肝門部膽管癌 63 例預后分析. 西部醫學, 2017, 29(7): 927-930, 934.
32.	董家鴻, 項燦宏, 石軍, 等. 以圍肝門切除為本的肝門膽管癌治愈性切除的臨床分析. 中華消化外科雜志, 2017, 16(10): 1053-1060.
33.	呂少誠, 潘冰, 賀強. 聯合肝臟切除術治療 Bismuth Ⅲb 型肝門部膽管癌的技術要點. 國際外科學雜志, 2017, 44(4): 265-267.
34.	管小青, 顧書成, 吳驥, 等. 聯合肝葉及入肝血管切除和重建治療肝門部膽管癌的臨床研究. 中國普外基礎與臨床雜志, 2015, 22(1): 64-69.
35.	黃慶國, 朱載陽, 李鵬澤. 擴大肝切除術治療Ⅲ至Ⅳ期肝門膽管癌的臨床價值. 癌癥進展, 2017, 15(3): 325-327.
36.	Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut, 2012, 61(12): 1657-1669.
37.	Miyazaki M, Yoshitomi H, Miyakawa S, et al. Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition. J Hepatobiliary Pancreat Sci, 2015, 22(4): 249-273.
38.	中華醫學會外科學分會膽道外科學組, 解放軍全軍肝膽外科專業委員會. 肝門部膽管癌診斷和治療指南 (2013 版). 中華外科雜志, 2013, 51(10): 865-871.
39.	國際肝膽胰學會中國分會, 中華醫學會外科學分會肝膽外科學組. 膽管癌診斷與治療—外科專家共識. 臨床肝膽病雜志, 2015, 31(1): 12-16.
40.	Olthof PB, Wiggers JK, Groot Koerkamp B, et al. Postoperative liver failure risk score: identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein emboli- zation. J Am Coll Surg, 2017, 225(3): 387-394.
41.	Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg, 2005, 242(3): 451-458.
42.	Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma. World J Gastroenterol, 2013, 19(48): 9209-9215.
43.	Loveday BPT, Knox JJ, Dawson LA, et al. Neoadjuvant hyperfractionated chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma in Canada. J Surg Oncol, 2018, 117(2): 213-219.
44.	Ghiassi-Nejad Z, Tarchi P, Moshier E, et al. Prognostic factors and patterns of locoregional failure after surgical resection in patients with cholangiocarcinoma without adjuvant radiation therapy: optimal field design for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys, 2017, 99(4): 805-811.
45.	Krasnick BA, Jin LX, Davidson JT 4^th, et al. Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: a multi-institution analysis from the U. S. extrahepatic biliary malignancy consortium. J Surg Oncol, 2018, 117(3): 363-371.
46.	李志海. 肝門部膽管癌經內鏡置入金屬支架結合局部放療療效分析. 中國實用醫藥, 2016, 11(4): 66-67.
47.	閆炫炫, 李多富, 李汛. 光動力療法在不可切除肝門部膽管癌中的應用. 中國普外基礎與臨床雜志, 2018, 25(4): 488-492.

1. 李斌, 張柏和, 姜小清. 解讀不同指南與共識的熱點及分歧、重視肝門部膽管癌的規范化診療. 中國普外基礎與臨床雜志, 2016, 23(11): 1293-1298.
2. Berardi R, Mocchegiani F, Pierantoni C, et al. Resected biliary tract cancers: a novel clinical-pathological score correlates with global outcome. Dig Liver Dis, 2013, 45(1): 70-74.
3. 蘇德望, 付先東, 于佳楠, 等. 血清糖類抗原 19-9、癌胚抗原在膽管癌診斷中的應用價值. 中國實驗診斷學, 2017, 21(10): 1693-1695.
4. Chen P, Li B, Zhu Y, et al. Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma. Oncotarget, 2016, 7(24): 37319-37330.
5. Lederer A, Herrmann P, Seehofer D, et al. Metastasis-associated in colon cancer 1 is an independent prognostic biomarker for survival in Klatskin tumor patients. Hepatology, 2015, 62(3): 841-850.
6. 陳雄飛, 周寧新, 張紅紅. FXYD6 在肝門膽管癌中的表達及臨床意義. 中國普外基礎與臨床雜志, 2016, 23(11): 1344-1347.
7. Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: recent advances and challenges. Radiology, 2018, 288(1): 7-13.
8. Ruys AT, van Beem BE, Engelbrecht MR, et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol, 2012, 85(1017): 1255-1262.
9. 倪其泓, 張赟和, 何敏, 等. 多排螺旋 CT 三維重建技術在肝門部膽管癌術前可切除性評估與手術規劃中的應用. 中華肝膽外科雜志, 2016, 22(7): 489-490.
10. 林科燦, 曾永毅, 黎蘊通, 等. 三維重建虛擬手術規劃在肝門部膽管癌手術中的應用價值. 中華消化外科雜志, 2018, 17(4): 383-388.
11. 張成軍. 常規磁共振成像聯合磁共振胰膽管成像對肝門部膽管癌的診斷價值. 新鄉醫學院學報, 2018, 35(3): 235-238.
12. Lee DH, Lee JM, Hur BY, et al. Colorectal cancer liver metastases: diagnostic performance and prognostic value of PET/MR imaging. Radiology, 2016, 280(3): 782-792.
13. Ma KW, Cheung TT, She WH, et al. Diagnostic and prognostic role of 18-FDG PET/CT in the management of resectable biliary tract cancer. World J Surg, 2018, 42(3): 823-834.
14. 修典榮, 王行雁. 肝門部膽管癌的精準外科診療進展. 國際外科學雜志, 2017, 44(7): 433-436.
15. 毛諒, 陳駿, 孫士全, 等. 美國癌癥聯合委員會肝門部膽管癌分期系統 (第 8 版) 更新解讀. 中國實用外科雜志, 2017, 37(5): 510-513.
16. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg, 1992, 215(1): 31-38.
17. 中國抗癌協會. 肝門部膽管癌規范化診治專家共識 (2015). 中華肝膽外科雜志, 2015, 21(8): 505-511.
18. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg, 2001, 234(4): 507-517.
19. Zaydfudim VM, Clark CJ, Kendrick ML, et al. Correlation of staging systems to survival in patients with resected hilar cholangiocarcinoma. Am J Surg, 2013, 206(2): 159-165.
20. Deoliveira ML, Schulick RD, Nimura Y, et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology, 2011, 53(4): 1363-1371.
21. 王杰, 劉厚寶. 肝門部膽管癌術前膽道引流的現狀和研究進展. 中華肝膽外科雜志, 2018, 24(1): 59-64.
22. 黃志強. 肝門部膽管癌外科治療的現狀與我見. 中國實用外科雜志, 2007, 27(5): 341-346.
23. Kawakubo K, Kawakami H, Kuwatani M, et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma. World J Gastrointest Endosc, 2016, 8(9): 385-390.
24. Jang SI, Hwang JH, Lee KH, et al. Percutaneous biliary approach as a successful rescue procedure after failed endoscopic therapy for drainage in advanced hilar tumors. J Gastroenterol Hepatol, 2017, 32(4): 932-938.
25. Dumitrascu T, Brasoveanu V, Stroescu C, et al. Major hepatectomies for perihilar cholangiocarcinoma: predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions. Asian J Surg, 2016, 39(2): 81-89.
26. Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
27. Marti J, Giacca M, Alshebeeb K, et al. Analysis of preoperative portal vein embolization outcomes in patients with hepatocellular carcinoma: a single-center experience. J Vasc Interv Radiol, 2018, 29(7): 920-926.
28. 杜成友, 肖衡. ALPPS 在原發性肝癌治療中的價值和評價. 中國普外基礎與臨床雜志, 2017, 24(12): 1435-1441.
29. 趙帥, 王許安, 劉穎斌. 肝門膽管癌的外科爭議及圍肝門切除. 肝膽胰外科雜志, 2016, 28(4): 346-350.
30. Robles R, Parrilla P, López-Conesa A, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg, 2014, 101(9): 1129-1134.
31. 張東, 陶杰, 耿智敏, 等. 聯合半肝切除肝門部膽管癌 63 例預后分析. 西部醫學, 2017, 29(7): 927-930, 934.
32. 董家鴻, 項燦宏, 石軍, 等. 以圍肝門切除為本的肝門膽管癌治愈性切除的臨床分析. 中華消化外科雜志, 2017, 16(10): 1053-1060.
33. 呂少誠, 潘冰, 賀強. 聯合肝臟切除術治療 Bismuth Ⅲb 型肝門部膽管癌的技術要點. 國際外科學雜志, 2017, 44(4): 265-267.
34. 管小青, 顧書成, 吳驥, 等. 聯合肝葉及入肝血管切除和重建治療肝門部膽管癌的臨床研究. 中國普外基礎與臨床雜志, 2015, 22(1): 64-69.
35. 黃慶國, 朱載陽, 李鵬澤. 擴大肝切除術治療Ⅲ至Ⅳ期肝門膽管癌的臨床價值. 癌癥進展, 2017, 15(3): 325-327.
36. Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut, 2012, 61(12): 1657-1669.
37. Miyazaki M, Yoshitomi H, Miyakawa S, et al. Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition. J Hepatobiliary Pancreat Sci, 2015, 22(4): 249-273.
38. 中華醫學會外科學分會膽道外科學組, 解放軍全軍肝膽外科專業委員會. 肝門部膽管癌診斷和治療指南 (2013 版). 中華外科雜志, 2013, 51(10): 865-871.
39. 國際肝膽胰學會中國分會, 中華醫學會外科學分會肝膽外科學組. 膽管癌診斷與治療—外科專家共識. 臨床肝膽病雜志, 2015, 31(1): 12-16.
40. Olthof PB, Wiggers JK, Groot Koerkamp B, et al. Postoperative liver failure risk score: identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein emboli- zation. J Am Coll Surg, 2017, 225(3): 387-394.
41. Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg, 2005, 242(3): 451-458.
42. Robles R, Sánchez-Bueno F, Ramírez P, et al. Liver transplantation for hilar cholangiocarcinoma. World J Gastroenterol, 2013, 19(48): 9209-9215.
43. Loveday BPT, Knox JJ, Dawson LA, et al. Neoadjuvant hyperfractionated chemoradiation and liver transplantation for unresectable perihilar cholangiocarcinoma in Canada. J Surg Oncol, 2018, 117(2): 213-219.
44. Ghiassi-Nejad Z, Tarchi P, Moshier E, et al. Prognostic factors and patterns of locoregional failure after surgical resection in patients with cholangiocarcinoma without adjuvant radiation therapy: optimal field design for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys, 2017, 99(4): 805-811.
45. Krasnick BA, Jin LX, Davidson JT 4^th, et al. Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: a multi-institution analysis from the U. S. extrahepatic biliary malignancy consortium. J Surg Oncol, 2018, 117(3): 363-371.
46. 李志海. 肝門部膽管癌經內鏡置入金屬支架結合局部放療療效分析. 中國實用醫藥, 2016, 11(4): 66-67.
47. 閆炫炫, 李多富, 李汛. 光動力療法在不可切除肝門部膽管癌中的應用. 中國普外基礎與臨床雜志, 2018, 25(4): 488-492.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress in diagnosis and treatment of hilar cholangiocarcinoma

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