Division of Surgical Oncology, Department of Surgery, University of Colorado Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Ann Surg Oncol. 2024 Oct;31(10):6504-6513. doi: 10.1245/s10434-024-15567-4. Epub 2024 Jul 7.
Resectable cholangiocarcinoma (CCA) arising from the middle of the extrahepatic biliary tree has historically been classified as perihilar or distal CCA, depending on the operation contemplated or performed, namely the associated hepatectomy or pancreaticoduodenectomy, respectively. Segmental bile duct resection is a less invasive alternative for select patients harboring true middle extrahepatic CCA (MCC). A small, yet growing body of literature has emerged detailing institutional experiences with bile duct resection versus pancreaticoduodenectomy or concomitant hepatectomy for MCC. Herein, we provide a brief overview of the epidemiology, preoperative evaluation, and emerging systemic therapies for MCC, and narratively review the existing work comparing segmental resection with pancreaticoduodenectomy or less commonly, hepatectomy, for MCC, with emphasis on the surgical management and oncologic implications of the approach used.
可切除的胆管癌（CCA）起源于肝外胆管的中部，根据所考虑或进行的手术，即相关的肝切除术或胰十二指肠切除术，历史上被分类为肝门周围或远端 CCA。对于某些患有真正的肝外胆管中部 CCA（MCC）的患者，节段性胆管切除术是一种侵袭性较小的选择。一小部分但不断增长的文献已经详细描述了机构在胆管切除术与胰十二指肠切除术或联合肝切除术治疗 MCC 方面的经验。在此，我们简要概述了 MCC 的流行病学、术前评估和新兴的系统治疗方法，并叙述性地回顾了比较 MCC 节段切除术与胰十二指肠切除术或较少见的肝切除术的现有工作，重点介绍所使用的手术管理和肿瘤学意义。
