Issues to Be Concerned in The Management of Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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何强 , 梁力建

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Keywords：

肝门部胆管癌; 外科治疗

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肝门部胆管癌（hilar cholangiocarcinoma），又称Klaskin癌，是指起源于左右肝管、分叉部和肝总管上段胆管上皮的恶性肿瘤，约占胆管癌的60%~70%［1］。由于其临床表现隐匿，早期难以被发现。目前根治性手术是最有效的提高其生存率的治疗方式，随着肝门部胆管癌R0切除率的不断升高，5年生存率不断提高［2，3］，但仍有不少问题有待于解决……

Citation： 何强,梁力建. Issues to Be Concerned in The Management of Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(11): 869-872. doi: Copy

1.	Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma [Ｊ]. Lancet， 2005; 366(9493): 1303-1314.
2.	DeOliveira ML, Cunningham SC, Cameron JL, et al. Cho-langiocarcinoma: thirty-one-year experience with 564 patients at a single institution [Ｊ]. Ann Surg, 2007; 245(5): 755-762.
3.	Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience [Ｊ]. Eur J Surg Oncol, 2008; 34(7): 787-794.
4.	Nagino M, Takada T, Miyazaki M, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas [Ｊ]. J Hepatobiliary Pancreat Surg, 2008; 15(1): 25-30.
5.	Nimura Y. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro) [Ｊ]. HPB (Oxford), 2008; 10(2): 130-133.
6.	陈东, 彭宝岗, 李绍强, 等. 肝门部胆管癌术前减黄临床价值 [Ｊ]. 中国实用外科杂志, 2007; 27(10): 805-808.
7.	Yokoyama Y, Nagino M, Nishio H, et al. Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 447-454.
8.	Komori K, Nagino M, Nimura Y. Hepatocyte morphology and kinetics after portal vein embolization [Ｊ]. Br J Surg, 2006; 93(6): 745-751.
9.	Nagino M, Kamiya J, Nishio H, et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up [Ｊ]. Ann Surg, 2006; 243(3): 364-372.
10.	de Baère T, Roche A, Amenabar JM, et al. Liver abscess formation after local treatment of liver tumors [Ｊ]. Hepatology, 1996; 23(6): 1436-1440.
11.	Doppman JL, Girton M, Vermess M. The risk of hepatic artery embolization in the presence of obstructive jaundice [Ｊ]. Radiology, 1982; 143(1): 37-43.
12.	Di Stefano DR, de Baere T, Denys A, et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients [Ｊ]. Radiology, 2005; 234(2): 625-630.
13.	Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual [S]. 6th eds. Berlin Heidelberg-New York: Springer, 2002.
14.	Nishio H, Nagino M, Oda K, et al. TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging sys [Ｊ]. Langenbecks Arch Surg, 2005; 390(4): 319-327.
15.	Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system [Ｊ]. Ann Surg, 1998; 228(3): 385-394.
16.	Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2001; 234(4): 507-517.
17.	Chen RF, Li ZH, Zhou JJ, et al. Preoperative evaluation with T-staging system for hilar cholangiocarcinoma [Ｊ]. World J Gastroenterol, 2007; 13(43): 5754-5759.
18.	彭承宏, 赵之明, 彭淑牖, 等. 用 T-分期系统回顾性分析 47例肝门部胆管癌 [Ｊ]. 中华外科杂志, 2005; 43 (1): 56-59.
19.	Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence [Ｊ]. Ann Surg, 2008; 248(2): 273-279.
20.	赖佳明，梁力建，李绍强，等. 手术切除治疗肝门部胆管癌 [Ｊ]. 中华肝胆外科杂志， 2006; 12(8): 509-511.
21.	Yubin L, Chihua F, Zhixiang J, et al. Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China [Ｊ]. Ann Surg Oncol, 2008; 15(8): 2113-2119.
22.	Tsalis K, Vasiliadis K, Kalpakidis V, et al. A single-center experience in the management of Altemeier-Klatskin tumors [Ｊ]. J Gastrointestin Liver Dis, 2007; 16(4): 383-389.
23.	周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [Ｊ]. 中华外科杂志, 2006; 44(23): 1599-1603.
24.	Ikeyama T, Nagino M, Oda K, et al. Surgical approach to bismuth Type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases [Ｊ]. Ann Surg, 2007; 246(6): 1052-1057.
25.	Paik KY, Choi DW, Chung JC, et al. Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma [Ｊ]. J Gastrointest Surg, 2008; 12(7): 1268-1274.
26.	van Gulik TM, Gouma DJ. Changing perspectives in the assessment of resectability of hilar cholangiocarcinoma [Ｊ]. Ann Surg Oncol, 2007; 14(7): 1969-1971.
27.	Hemming AW, Kim RD, Mekeel KL, et al. Portal vein resection for hilar cholangiocarcinoma [Ｊ]. Am Surg, 2006; 72(7): 599-604.
28.	Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? [Ｊ]. Surgery, 2007; 141(5): 581-588.
29.	韩风, 周进学, 张玲, 等. 肝叶切除联合门静脉切除和重建在肝门部胆管癌根治术中的应用 [Ｊ]. 中华外科杂志， 2007； 45（11）： 763-765.
30.	Sakamoto Y, Sano T, Shimada K, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy [Ｊ]. Langenbecks Arch Surg, 2006; 391(3): 203-208.
31.	Miyazaki M, Kimura F, Shimizu H, et al. Recent advance in the treatment of hilar cholangiocarcinoma: hepatectomy with vascular resection [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 463-468.
32.	黄志强. 肝门部胆管癌外科治疗观念能否有所转变 [Ｊ]. 临床外科杂志, 2008; 16(1): 3-4.
33.	Han SS, Jang JY, Lee KU, et al. Actual long-term outcome of Klatskin’s tumor after surgical resection [Ｊ]. Hepatogastroenterology, 2008; 55(88): 1986-1992.
34.	孙学军，石景森，何平, 等. 影响胆管癌切除术后的预后因素分析 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 85-88.
35.	Nagino M, Kamiya J, Arai T, et al. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2006; 243(1): 28-32.
36.	Pinson CW, Rossi RL. Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancer [Ｊ]. World J Surg, 1988; 12(1):52-59.
37.	Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 1992; 215(1): 31-38.
38.	Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection [Ｊ]. Ann Surg, 2001; 233(3): 385-392.
39.	蔡秀军，沈波. 肝门部胆管癌术中淋巴结清扫 [Ｊ]. 中国实用外科杂志， 2007; 27(5): 366-367.
40.	Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes [Ｊ]. J Am Coll Surg, 2007; 204(2): 250-260.
41.	Tojima Y, Nagino M, Ebata T, et al. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2003; 237(2): 201-207.
42.	Jonas S, Benckert C, Thelen A, et al. Radical surgery for hilar cholangiocarcinoma [Ｊ]. Eur J Surg Oncol, 2008; 34(3): 263-271.
43.	Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2005; 242(3): 451-458.
44.	Thelen A, Neuhaus P. Liver transplantation for hilar cholangiocarcinoma [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 469-475.

1. Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma [Ｊ]. Lancet， 2005; 366(9493): 1303-1314.
2. DeOliveira ML, Cunningham SC, Cameron JL, et al. Cho-langiocarcinoma: thirty-one-year experience with 564 patients at a single institution [Ｊ]. Ann Surg, 2007; 245(5): 755-762.
3. Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience [Ｊ]. Eur J Surg Oncol, 2008; 34(7): 787-794.
4. Nagino M, Takada T, Miyazaki M, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas [Ｊ]. J Hepatobiliary Pancreat Surg, 2008; 15(1): 25-30.
5. Nimura Y. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro) [Ｊ]. HPB (Oxford), 2008; 10(2): 130-133.
6. 陈东, 彭宝岗, 李绍强, 等. 肝门部胆管癌术前减黄临床价值 [Ｊ]. 中国实用外科杂志, 2007; 27(10): 805-808.
7. Yokoyama Y, Nagino M, Nishio H, et al. Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 447-454.
8. Komori K, Nagino M, Nimura Y. Hepatocyte morphology and kinetics after portal vein embolization [Ｊ]. Br J Surg, 2006; 93(6): 745-751.
9. Nagino M, Kamiya J, Nishio H, et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up [Ｊ]. Ann Surg, 2006; 243(3): 364-372.
10. de Baère T, Roche A, Amenabar JM, et al. Liver abscess formation after local treatment of liver tumors [Ｊ]. Hepatology, 1996; 23(6): 1436-1440.
11. Doppman JL, Girton M, Vermess M. The risk of hepatic artery embolization in the presence of obstructive jaundice [Ｊ]. Radiology, 1982; 143(1): 37-43.
12. Di Stefano DR, de Baere T, Denys A, et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients [Ｊ]. Radiology, 2005; 234(2): 625-630.
13. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual [S]. 6th eds. Berlin Heidelberg-New York: Springer, 2002.
14. Nishio H, Nagino M, Oda K, et al. TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging sys [Ｊ]. Langenbecks Arch Surg, 2005; 390(4): 319-327.
15. Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system [Ｊ]. Ann Surg, 1998; 228(3): 385-394.
16. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2001; 234(4): 507-517.
17. Chen RF, Li ZH, Zhou JJ, et al. Preoperative evaluation with T-staging system for hilar cholangiocarcinoma [Ｊ]. World J Gastroenterol, 2007; 13(43): 5754-5759.
18. 彭承宏, 赵之明, 彭淑牖, 等. 用 T-分期系统回顾性分析 47例肝门部胆管癌 [Ｊ]. 中华外科杂志, 2005; 43 (1): 56-59.
19. Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence [Ｊ]. Ann Surg, 2008; 248(2): 273-279.
20. 赖佳明，梁力建，李绍强，等. 手术切除治疗肝门部胆管癌 [Ｊ]. 中华肝胆外科杂志， 2006; 12(8): 509-511.
21. Yubin L, Chihua F, Zhixiang J, et al. Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China [Ｊ]. Ann Surg Oncol, 2008; 15(8): 2113-2119.
22. Tsalis K, Vasiliadis K, Kalpakidis V, et al. A single-center experience in the management of Altemeier-Klatskin tumors [Ｊ]. J Gastrointestin Liver Dis, 2007; 16(4): 383-389.
23. 周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [Ｊ]. 中华外科杂志, 2006; 44(23): 1599-1603.
24. Ikeyama T, Nagino M, Oda K, et al. Surgical approach to bismuth Type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases [Ｊ]. Ann Surg, 2007; 246(6): 1052-1057.
25. Paik KY, Choi DW, Chung JC, et al. Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma [Ｊ]. J Gastrointest Surg, 2008; 12(7): 1268-1274.
26. van Gulik TM, Gouma DJ. Changing perspectives in the assessment of resectability of hilar cholangiocarcinoma [Ｊ]. Ann Surg Oncol, 2007; 14(7): 1969-1971.
27. Hemming AW, Kim RD, Mekeel KL, et al. Portal vein resection for hilar cholangiocarcinoma [Ｊ]. Am Surg, 2006; 72(7): 599-604.
28. Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? [Ｊ]. Surgery, 2007; 141(5): 581-588.
29. 韩风, 周进学, 张玲, 等. 肝叶切除联合门静脉切除和重建在肝门部胆管癌根治术中的应用 [Ｊ]. 中华外科杂志， 2007； 45（11）： 763-765.
30. Sakamoto Y, Sano T, Shimada K, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy [Ｊ]. Langenbecks Arch Surg, 2006; 391(3): 203-208.
31. Miyazaki M, Kimura F, Shimizu H, et al. Recent advance in the treatment of hilar cholangiocarcinoma: hepatectomy with vascular resection [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 463-468.
32. 黄志强. 肝门部胆管癌外科治疗观念能否有所转变 [Ｊ]. 临床外科杂志, 2008; 16(1): 3-4.
33. Han SS, Jang JY, Lee KU, et al. Actual long-term outcome of Klatskin’s tumor after surgical resection [Ｊ]. Hepatogastroenterology, 2008; 55(88): 1986-1992.
34. 孙学军，石景森，何平, 等. 影响胆管癌切除术后的预后因素分析 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 85-88.
35. Nagino M, Kamiya J, Arai T, et al. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2006; 243(1): 28-32.
36. Pinson CW, Rossi RL. Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancer [Ｊ]. World J Surg, 1988; 12(1):52-59.
37. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 1992; 215(1): 31-38.
38. Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection [Ｊ]. Ann Surg, 2001; 233(3): 385-392.
39. 蔡秀军，沈波. 肝门部胆管癌术中淋巴结清扫 [Ｊ]. 中国实用外科杂志， 2007; 27(5): 366-367.
40. Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes [Ｊ]. J Am Coll Surg, 2007; 204(2): 250-260.
41. Tojima Y, Nagino M, Ebata T, et al. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2003; 237(2): 201-207.
42. Jonas S, Benckert C, Thelen A, et al. Radical surgery for hilar cholangiocarcinoma [Ｊ]. Eur J Surg Oncol, 2008; 34(3): 263-271.
43. Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2005; 242(3): 451-458.
44. Thelen A, Neuhaus P. Liver transplantation for hilar cholangiocarcinoma [Ｊ]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 469-475.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Issues to Be Concerned in The Management of Hilar Cholangiocarcinoma

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