Alejandro Serrablo, Medicine School of Zaragoza University, HPB Surgical Unit, Miguel Servet University Hospital, 50009 Zaragoza, Spain.
World J Gastrointest Oncol. 2013 Jul 15;5(7):147-58. doi: 10.4251/wjgo.v5.i7.147.
Cholangiocarcinomas are the second most frequent primary hepatic malignancy, and make up from 5% to 30% of malignant hepatic tumours. Hilar cholangiocarcinoma (HCC) is the most common type, and accounts for approximately 60% to 67% of all cholangiocarcinoma cases. There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease. Neither the extension of resection, according to the sort of HCC, is a closed topic. Some authors defend limited resection (mesohepatectomy with S1, S1 plus S4b-S5, local excision for papillary tumours, etc.) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure. As there is not an ideal adjuvant therapy, R1 resection can be justified to prolong the survival rate. Morbidity and mortality rates changed along the last decade, but variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively.
Surgical resection continues to be the main treatment of HCC. Negative resection margins achieved with major hepatic resections are associated with improved outcome. Preresectional management with biliary drainage, portal vein embolization and staging laparoscopy should be considered in selected patients. Additional evidence is needed to fully define the role of orthotopic liver transplant. Portal and lymph node involvement worsen the prognosis and long-term survival, and surgery is the only option that can lengthen it. Improvements in adjuvant therapy are essential for improving long-term outcome. Furthermore, the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option, because operated patients have a longer survival rate than those who not undergo surgery.
胆管癌是第二常见的原发性肝恶性肿瘤，占肝脏恶性肿瘤的 5%至 30%。肝门部胆管癌（HCC）是最常见的类型，约占所有胆管癌病例的 60%至 67%。没有一个分期系统可以让我们比较所有的系列，并从中得出一些结论，以提高这种恶性疾病的长期生存率。根据 HCC 的类型，扩大切除术的范围也不是一个确定的话题。一些作者主张进行有限的切除术（S1 节段切除术、S1 加 S4b-S5 节段切除术、乳头状肿瘤的局部切除术等），而另一些作者则坚持必须进行广泛的肝切除术，包括门静脉分叉切除，以达到治愈的目的。由于没有理想的辅助治疗方法，R1 切除术可以延长生存率。过去十年，发病率和死亡率发生了变化，但变化是常态，发病率和死亡率分别为 14%至 76%和 0%至 19%。
手术切除仍然是 HCC 的主要治疗方法。通过广泛的肝切除术实现的阴性切缘与改善的结果相关。对于选定的患者，应考虑在术前进行胆道引流、门静脉栓塞和分期腹腔镜检查的预处理管理。需要更多的证据来充分定义原位肝移植的作用。门静脉和淋巴结受累会恶化预后和长期生存，手术是唯一可以延长生存时间的选择。辅助治疗的改进对于改善长期预后至关重要。此外，缺乏有效的化疗药物和放疗方法，这使得我们可以考虑将 R1 切除术作为一种选择，因为接受手术的患者比未接受手术的患者有更长的生存时间。
