Research progress on resectability assessment of hilar cholangiocarcinoma / 中华肝胆外科杂志

ABSTRACT

Hilar cholangiocarcinoma (HCC) resection is a difficult and complicated surgery with high complication risk because of the special anatomic position.The detailed preoperative assessment is very important.Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can provide important information on the tumor location, vascular invasion and distant metastasis, which is necessary for the resection.Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) can be used to determine the tumor location and size, and achieve bile drainage.Magnetic resonance Cholangiopancreatolography (MRCP) as a noninvasive examination with fewer complications has comparable accuracy in identifying tumor extent with PTC and ERCP.The ultimate goal of surgical treatment is R0 resection.Preoperative resectablility evaluation mainly depends on the bile duct involvement, hilar vessels invasion, extent of hepatic lobe atrophy, lymphatic metastasis and nerve plexus infiltration.HCC radical resection often demands extended liver resection and accurate assessment of the residual liver function is very important for clinical strategy.Preoperative biliary drainage could be conducted in patients with cholangitis, long-term refractory jaundice (direct bilirubin level ＞ 200 μmol/L), poor nutrition status and residual liver volume ＜40％ of the total liver volume.Portal vein embolization decreases the long-term complications for HCC patients with enlarged liver resection.Portal vein embolization can be considered when residual liver volume ＜ 30％ ～40％.