Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | sâmbătă, 16 februarie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
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CHOLANGIOCARCINOMA: STRATEGY OF DIAGNOSTIC AND TREATMENT
C. Gouillat
Department of Surgery, C.H.U. Hotel Dieu, Lyon, France
University Claude Bernard, Lyon I
Jurnalul de chirurgie 2005; 1 (4):447-456
Full text: Format Multimedia - HTML Format PDF (franceza)

Abstract:

Cancers of the biliary tree located within the hilum of the liver, are classified according to the pattern of right and left hepatic ductal involvement (Bismuth classification). For this kind of cancers (Klatskin tumors) the treatment is controversy. The diagnosis and tumor stage are established by some explorations: ultrasound exam, computed tomography (CT), helical CT, MRI (magnetic resonance imagery), ERCP (endoscopic retrograde cholangiopancreatography).

The laparoscopic assessment is useful (with intraoperative ultrasonography) and had an accuracy of 53% in some papers. There are two therapeutic strategies: the "aggressive" attitude (surgical resection) and palliative treatment. Surgical resections are indicated in elective patients; these techniques include hepatectomies, resection of the main biliary duct, cholecystectomy and sometimes, hepato-duodeno-pancreatectomy.

The most optimistic statistics show a postoperative mortality of 10%, a morbidity of 60% and a R0 resection rate of 60%. The mean survival rate was 30-40 month. Palliative treatment includes: the trans-tumoral endo-prothesis (inserted by surgery or, better, by minimally invasive techniques - ERCP, interventional radiology) and percutaneous external biliary drainage.

 Conclusions: A correct assessment of the Klatskin tumors is necessary for therapeutic strategy. The aggressive surgical treatment is indicated only in elective patients and with a multidisciplinary team. Surgeons are playing a key role in the management of cholangiocarcinoma.

KEYWORDS: CHOLANGIOCARCINOMA, KLATSKIN TUMOR, DUODENO-PANCREATECTOMY



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Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.