Fernando Rotellar, Fernando Pardo, HPB and Liver Transplant Unit, Department of General and Abdominal Surgery, University Clinic of Navarre, University of Navarre, 31008 Pamplona, Spain.
World J Gastrointest Oncol. 2013 Jul 15;5(7):127-31. doi: 10.4251/wjgo.v5.i7.127.
Radical resection remains the only potential curative therapy for hilar cholangiocarcinoma (HCCA). The aim of staging laparoscopic (SL) is to identify patients with previously undetected advanced disease who will not benefit from surgical palliation and therefore avoid unnecessary laparotomies. The accuracy of non-invasive imaging techniques has significantly improved during the last years. As a consequence, the diagnostic yield of SL of biliary tract malignancy should have decreased proportionally. At the same time, some authors have recently questioned the value of laparoscopic ultrasound (LUS) as a complement of SL. In this setting, the precise role of SL and LUS in the preoperative workup of HCCA remains unclear. As it seems undoubtedly clear that its efficacy has decreased in the last decades, there is a general consensus that the universal use of SL shouldn't be recommended anymore; SL should be performed only in selected patients with higher risk of holding unresectable disease (T2/T3 or Bismuth type 3/4 and patients with suspicion of metastases). It would also be recommended in patients with potentially resectable disease who would need preoperative invasive procedures. Finally, SL should be performed preceding laparotomy in one session. Further studies on the benefit of SL and LUS in this subset of HCCA patients are warranted.
根治性切除术仍然是肝门部胆管癌（HCCA）唯一潜在的治愈性治疗方法。腹腔镜分期（SL）的目的是识别以前未发现的、无法从手术姑息治疗中获益的晚期疾病患者，从而避免不必要的剖腹手术。近年来，非侵入性成像技术的准确性有了显著提高。因此，胆道恶性肿瘤 SL 的诊断率应该相应降低。与此同时，最近一些作者对腹腔镜超声（LUS）作为 SL 的补充的价值提出了质疑。在这种情况下，SL 和 LUS 在 HCCA 术前评估中的精确作用仍不清楚。由于其在过去几十年中的疗效明显下降，人们普遍认为不应该再推荐广泛使用 SL；SL 仅应在具有更高不可切除疾病风险的患者中进行（T2/T3 或 Bismuth 3/4 型和怀疑转移的患者）。对于需要术前侵袭性操作的潜在可切除疾病患者，也建议进行 SL。最后，SL 应在一次手术中进行，然后再进行剖腹手术。需要进一步研究 SL 和 LUS 在这部分 HCCA 患者中的获益。
