Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment |
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Authors: | Kondo Satoshi Takada Tadahiro Miyazaki Masaru Miyakawa Shuichi Tsukada Kazuhiro Nagino Masato Furuse Junji Saito Hiroya Tsuyuguchi Toshio Yamamoto Masakazu Kayahara Masato Kimura Fumio Yoshitomi Hideyuki Nozawa Satoshi Yoshida Masahiro Wada Keita Hirano Satoshi Amano Hodaka Miura Fumihiko;Japanese Association of Biliary Surgery;Japanese Society of Hepato-Biliary-Pancreatic Surgery;Japan Society of Clinical Oncology |
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Institution: | (1) Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan;(2) Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan;(3) Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan;(4) Department of Gastroenterological Surgery, Fujita Health University, Toyoake, Japan;(5) Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan;(6) Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;(7) Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Chiba, Japan;(8) Department of Radiology, Asahikawa Kosei General Hospital, Asahikawa, Japan;(9) Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan;(10) Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan;(11) Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan |
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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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Keywords: | Biliary tract neoplasms Bile duct neoplasms Gallbladder neoplasms Ampulla of Vater Surgery Guidelines |
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