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  • Hilar Cholangiocarcinoma: Therapeutic Strategies: MT Khalfallah

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    Khalfallah Mohamed Tahar
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    This document discusses hilar cholangiocarcinoma, a type of cancer located in the upper part of the bile duct. It covers definitions, staging methods like CT scans and MRCP, and therapeutic options. The main treatment approaches are surgical resection, which aims to remove the tumor with clear margins, and palliative options like stenting if resection is not possible. Factors like local tumor spread, lymph node involvement, and achieving a radical resection impact survival outcomes. Preoperative evaluation and drainage of the bile ducts can help determine resectability and protect the liver remnant. The type of hepatic resection performed depends on the extent of tumor invasion.

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    This document discusses hilar cholangiocarcinoma, a type of cancer located in the upper part of the bile duct. It covers definitions, staging methods like CT scans and MRCP, and therapeutic options. The main treatment approaches are surgical resection, which aims to remove the tumor with clear margins, and palliative options like stenting if resection is not possible. Factors like local tumor spread, lymph node involvement, and achieving a radical resection impact survival outcomes. Preoperative evaluation and drainage of the bile ducts can help determine resectability and protect the liver remnant. The type of hepatic resection performed depends on the extent of tumor invasion.

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    41 views49 pages

    Hilar Cholangiocarcinoma: Therapeutic Strategies: MT Khalfallah

    Uploaded by

    Khalfallah Mohamed Tahar
    This document discusses hilar cholangiocarcinoma, a type of cancer located in the upper part of the bile duct. It covers definitions, staging methods like CT scans and MRCP, and therapeutic options. The main treatment approaches are surgical resection, which aims to remove the tumor with clear margins, and palliative options like stenting if resection is not possible. Factors like local tumor spread, lymph node involvement, and achieving a radical resection impact survival outcomes. Preoperative evaluation and drainage of the bile ducts can help determine resectability and protect the liver remnant. The type of hepatic resection performed depends on the extent of tumor invasion.

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    of 49

    Hilar Cholangiocarcinoma :

    Therapeutic Strategies
    MT KHALFALLAH
    Definition

     Upper biliary confluence

     Proximal main bile duct

     Up to the cytico-choledocal junction


    Treatment
    Preoperative Evaluation
     Local spread :

    • Longitudinal
    • Radial

     Lymphatic spread

     Metastases
    Staging means
     Ultrasound

     CT (Spiral)

     MRI (MRCP)

     Angiography

     ERCP / TPC

     PET Scan
    Therapeutic Options
     Curative :
    • Surgical resection
    • Adjuvant Therapies : chemo and /or radiotherapy

     Palliative:
    • Stenting
    • Radiotherapy
    • Chemotherapy
    Curative Resection
     Tumor Removal

    • Free margins

     Parenchymal resection

    • Lymphadenectomy

    • Metastasis
    What questions should we ask to the
    radiologist ?
     Definition of Hilar anatomy
     Extent of the tumor along the bile duct :
    • Second order Confluences
     Extent to vascular components
    • Hepatic artery
    • Portal vein
     Parenchymal atrophy
     Volume and patern of the residual Liver
    parenchyma
    Local Extent
    Shimizu et al Annals of Surgery • Volume 249, Number 3, March 2009
    Shimizu et al Annals of Surgery • Volume 249, Number 3, March 2009
    Surgical Resection
     The tumor with enough margins
    • Segment I
    • Segment IV

     Extended Left hepatectomy


    • SGT I,II,II, IV

     Extended right hepatectomy


    • SGT I, IV, V, VI, VII, VIII

     Central Hepatectomy :
    • SGT I, IV, V, VIII
    Extended Left Hepatectomy
    Extended Left Hepatectomy
    Central Hepatectomy
    What about Lateral Spread ?
    Preoperative Preparation
     Unspecific

     Biliary drainage

     Portal embolisation
    Biliary Drainage
     Bile ducts infection

     Protects remanent parenchyma

     For how long ?


    Remanent Volume

     30-40 % of the liver volume

     1% of the body weight

     Portal Branches Embolization


    Type of Resection
    Type I
     Biliary confluence

     Proximal bile duct

     Segment I

     Segment IV

     Left Hepatectomy
    Type II
     Biliary confluence

     Proximal bile duct

     Segment I

     Segment IV

     Left Hepatectomy
    Type III
     Type III a :
    • Extended right hepatectomy

     Type III b :
    • Extended left hepatectomy
    Type IV
     No Resection

     Resection of I, II, III, IV, V, VIII

     Liver Transplantation
    RESULTS
    Miyazaki et al. Surgery 1998;123:131-6
    Survival according to proximal
    ductal margin status

    ji Shingu, Surgery (2010) 1; 147


    Survival / Nodal involvement status

    __ N0
    --- N1
    … N2
    Survival / Perineural invasion
    Survival / Radicality
    Miyazaki et al. Surgery 1998;123:131-6
    Hiroaki Shimizu et al. Ann Surg 2010;251: 281–286

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