Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment.
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| Abstract |
The only curative treatment in biliary tract cancer is surgical treatment. Therefore, the suitability of curative resection should be investigated in the first place. In the presence of metastasis to the liver, lung, peritoneum, or distant lymph nodes, curative resection is not suitable. No definite consensus has been reached on local extension factors and curability. Measures of hepatic functional reserve in the jaundiced liver include future liver remnant volume and the indocyanine green (ICG) clearance test. Preoperative portal vein embolization may be considered in patients in whom right hepatectomy or more, or hepatectomy with a resection rate exceeding 50%-60% is planned. Postoperative complications and surgery-related mortality may be reduced with the use of portal vein embolization. Although hepatectomy and/or pancreaticoduodenectomy are preferable for the curative resection of bile duct cancer, extrahepatic bile duct resection alone is also considered in patients for whom it is judged that curative resection would be achieved after a strict diagnosis of its local extension. Also, combined caudate lobe resection is recommended for hilar cholangiocarcinoma. Because the prognosis of patients treated with combined portal vein resection is significantly better than that of unresected patients, combined portal vein resection may be carried out. Prognostic factors after resection for bile duct cancer include positive surgical margins, especially in the ductal stump; lymph node metastasis; perineural invasion; and combined vascular resection due to portal vein and/or hepatic artery invasion. For patients with suspected gallbladder cancer, laparoscopic cholecystectomy is not recommended, and open cholecystectomy should be performed as a rule. When gallbladder cancer invading the subserosal layer or deeper has been detected after simple cholecystectomy, additional resection should be considered. Prognostic factors after resection for gallbladder cancer include the depth of mural invasion; lymph node metastasis; extramural extension, especially into the hepatoduodenal ligament; perineural invasion; and the degree of curability. Pancreaticoduodenectomy is indicated for ampullary carcinoma, and limited operation is also indicated for carcinoma in adenoma. The prognostic factors after resection for ampullary carcinoma include lymph node metastasis, pancreatic invasion, and perineural invasion.
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| Authors | Satoshi Kondo, Tadahiro Takada, Masaru Miyazaki, Shuichi Miyakawa, Kazuhiro Tsukada, Masato Nagino, Junji Furuse, Hiroya Saito, Toshio Tsuyuguchi, Masakazu Yamamoto, Masato Kayahara, Fumio Kimura, Hideyuki Yoshitomi, Satoshi Nozawa, Masahiro Yoshida, Keita Wada, Satoshi Hirano, Hodaka Amano, Fumihiko Miura, Japanese Association of Biliary Surgery, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Japan Society of Clinical Oncology |
| Journal | Journal of hepato-biliary-pancreatic surgery (J Hepatobiliary Pancreat Surg) Vol. 15 Issue 1 Pg. 41-54 ( 2008) ISSN: 0944-1166 [Print] Japan |
| PMID | 18274843 (Publication Type: Journal Article, Practice Guideline, Research Support, Non-U.S. Gov't) |
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