20

944 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
944
On SlideShare
0
From Embeds
0
Number of Embeds
21
Actions
Shares
0
Downloads
32
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

20

  1. 1. Variable outcomes of surgical treatment for intrahepatic and hilar cholangiocarcinoma? Department of Surgery and Transplantation Department of Surgery and Transplantation University of Bologna University of Bologna
  2. 2. Definition of Cholangiocarcinoma Weimann, Br J Surg 2000; 87:1182-87 Review of the international literature: • Intrahepatic type  Intrahepatic bile duct carcinoma  Peripheral cholangiocarcinoma  Cholangiocellular carcinoma (CCC) • Extrahepatic type  Biliary confluence (Klatskin’s tumor)  Distal bile duct Cholangiocarcinoma is the second most common malignant tumor of the liver Cholangiocarcinoma is the second most common malignant tumor of the liver
  3. 3. Cholangiocellular Carcinoma Aetiological Factors • Western countries  associated only with primary sclerosing cholangitis (PSC) in about 6-11% of cases (Chalasani, Hepatology 2000) • Eastern countries (10 times more frequent)  hepatobiliary parassitosis (Chen, Dig Dis Sci 2000)  intrahepatic lithiasis (Groen, New Eng J Med 2000)  intrahepatic biliary cysts
  4. 4. Variable outcomes of surgical treatment for intrahepatic and hilar cholangiocarcinoma? • To evaluate any clinico-pathologic differences between intrahepatic cholangiocarcinoma and Klatskin’s tumor, early and long term results after surgical therapy for cholangiocarcinoma were retrospectively reviewed in a 15-year Single Center’s experience
  5. 5. 1188 Liver Resections 1188 Liver Resections Others Others HCC HCC Trauma Trauma 88 88 121 121 22 22 Benign Tumors Benign Tumors 151 151 HCC on Cirrhosis HCC on Cirrhosis 311 311 Intrahepatic Intrahepatic cholangioca. cholangioca. 34 (2.9%) 34 (2.9%) Repeated Resections Repeated Resections 50 Klatskin Tumor Klatskin Tumor 50 25 (2.1%) 25 (2.1%) Metastases Metastases 390 390
  6. 6. Liver Resections for Cholangiocarcinoma 59 patients 34 25 Peripheral CC Klatskin’s tumor 27 Cholangiocarcinoma 7 mixed form (Sasaki, J Surg Oncol 2001)
  7. 7. 59 Liver Resections for Cholangiocarcinoma Patient Characteristics Klatskin tumor Peripheral CC (25 patients) (34 patients) Gender 14 M / 7 F 14 M / 17 F Age 58.1 ± 10.3 62.0 ± 9.0 Diameter 2.5 ± 0.7 6.9 ± 5.7 Symptoms Pain 5 (20.0%) 20 (58.8%) Jaundice 19 (76.0%) 2 (5.8%) None 1 (4.0%) 13 (35.4%)
  8. 8. 59 Liver Resections for Cholangiocarcinoma Operative Procedures Klatskin Tumor Peripheral CC (25 patients) (34 patients) Segmentectomies - 16 (47.1%) Major hepatectomies 8 (32%)* 8 (23.5%) Extended major 17 (68%)* 10 (29.4%) hepatectomies * In 14 cases, right portal vein embolization was applied
  9. 9. 59 Liver Resections for Cholangiocarcinoma Early postoperative outcome Klatskin Tumor Peripheral CC (25 patients) (34 patients) Postop. Morbidity 14 (56%) 9 (26.4%) Postop. Mortality 3 (12%)* 1 (2.9%)* 4 / 59 Patients ( 6.7 % ) * p < 0.05
  10. 10. 59 Liver Resections for Cholangiocarcinoma Overall survival 100 80 60 48.8% % 35.4% 40 20 0 0 6 12 18 24 30 36 42 48 54 60 Months
  11. 11. 59 Liver Resections for Cholangiocarcinoma Survival by Type of Tumors 100 80 p=n.s. 60 % 40 20 Klatskin tumor Peripheral CC 0 0 6 12 18 24 30 36 42 48 54 60 Months
  12. 12. 59 Liver Resections for Cholangiocarcinoma Resection vs palliative treatment 100 75 p<0.01 % 50 35.4% 25  Palliative treat. (56 cases) 0  Resection (59 cases) 0 12 24 36 48 60
  13. 13. 59 Liver Resections for Cholangiocarcinoma Pathologic characteristics Vascular Perineural Lymph node thrombosis invasion metastases Klatskin’s 6 (24%) 16 (64%)* 9 (36%) tumor Intrahepatic 9 (26.4%) 3 (8.8%)* 10 (29.4%) cholangio-ca. * p < 0.05
  14. 14. Biological prognostic parameters •p53 mutation •c-erbB-2 •c-met •Muc1 expression
  15. 15. Cholangiocellular carcinoma Overall survival depending on p27 expression Fiorentino, et al. Clinic Cancer Research 2001; 7: 3994-9 100 75 p<0.001 % 50 25  p27 absent  p27 present 0 0 12 24 36 48 60
  16. 16. 59 Liver Resections for Cholangiocarcinoma Relation between p27 and recurrence p27 p27 present absent Postop.recurrence 22% 77.8% p < 0.05 Absence of 66.7% 33.3% recurrence
  17. 17. CONCLUSIONS (I) • Cholangiocarcinoma is a highly aggressive tumor with a generally poor prognosis. • Liver resection is the treatment of choice leading to a 5-year survival varying from 25% to 40%. • The possibility of long-term survival depends on the feasibility of performing surgical resection with radical intent.
  18. 18. CONCLUSIONS (II) • In case of Klatskin's tumor curative procedures can be achieved by extended hepatectomies. Preoperative portal vein embolization may reduce the rate of postoperative morbidity and mortality. • ICC has a lower biological aggressiveness and needs a minor resection. • Evaluation by molecular biology of new prognostic factors may significantly influence therapeutic strategies in these patients and it could also be useful for planning adjuvant therapies during follow-up.

×