Editorial Open Access
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World J Gastrointest Oncol. Jul 15, 2013; 5(7): 113-114
Published online Jul 15, 2013. doi: 10.4251/wjgo.v5.i7.113
Hilar cholangiocarcinoma
José M Ramia
José M Ramia, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
Author contributions: Ramia JM solely contributed to this paper.
Correspondence to: José M Ramia, MD, PhD, Department of Surgery, Hospital Universitario de Guadalajara, Donante de Sangre, S/N, 19002 Guadalajara, Spain. jose_ramia@hotmail.com
Telephone: +34-61-6292056 Fax: +34-94-9209218
Received: March 11, 2013
Revised: June 16, 2013
Accepted: July 4, 2013
Published online: July 15, 2013

Abstract

Hilar cholangiocarcinoma (HC) is a rare tumor. It accounts for 2/3 of the tumors of the biliary tract. Untreated, prognosis is very poor. Surgery is the only therapy that offers the possibility of cure but is technically very complex. With recent improvements in the therapeutic strategies applied by multidisciplinary teams, survival rates in the different series currently range from 25% to 45%. A group of experts devoted to HC (pathologists, gastroenterologists, radiologists, surgeons and oncologists) have reviewed and updated every open question in HC in a special issue.

Key Words: Cholangiocarcinoma, Hilar, Perihilar, Klatskin, Surgery, Cancer, Review

Core tip: Most remarked avances are: imaging methods have improved diagnostic sensitivity and specificity, especially for determining biliary and vascular involvement; there have been several proposals to improve the classic Bismuth-Corlette classification; pre- and post-operative care; technical aspects trying to obtain a R0 resection: widespread use of liver resection, resection of segment I and venous and arterial resection, refinement of post-operative histology and adjuvant therapies.



EDITORIAL

Hilar cholangiocarcinoma (HC) is a rare tumor (0.74-1.05×100000 inhabitants), representing 3% of gastrointestinal cancers[1,2]. It accounts for 2/3 of the tumors of the biliary tract[1]. Although HC is frequently discussed at surgical scientific meetings and arouses great interest, it has far fewer citations than other HPB cancers and several questions regarding the condition remain unanswered in the medical literature.

Untreated, the prognosis of HC is very poor. Surgery is the only therapy that offers the possibility of cure but is technically very complex[1,3]. A few years ago, the number of patients operated and resected was very low, and 5-year survival was mediocre. With recent improvements in the therapeutic strategies applied by multidisciplinary teams comprising radiologists, gastroenterologists, surgeons and oncologists, survival rates in the different series currently range from 25% to 45%[3,4].

A group of experts devoted to HC (pathologists, gastroenterologists, radiologists, surgeons and oncologists) have reviewed and updated every open question in HC in this special issue focusing in the following areas of the management and treatment of patients with HC:

Prof. Valls et al[5] has updated diagnostic methods in HC: Imaging methods have improved diagnostic sensitivity and specificity, especially for determining biliary and vascular involvement. These methods include multidetector computed tomography, Cholangio-magnetic resonance, percutaneous transhepatic cholangioscopy, positron emission tomography computed tomography and staging by laparoscopy reviewed by Prof. Rotellar et al[6].

Prof. Suarez-Munoz et al[7] have updated the classification/staging systems in HC: There have been several proposals to improve the classic Bismuth-Corlette classification, among them the Memorial Sloan-Kettering Center system, the 7th edition of TNM, and the most complete system so far devised by de DeOliveira et al[2]. Correct preoperative staging is essential to identify the patients who should be operated.

Prof. Ramos[8] has devoted his paper to perioperative care and technical aspects: Several pre-operative measures have been used to minimize risks and improve results: uni- or bi-lobar pre-operative biliary drainage, the use of probiotics, autologous blood, replacement of drained bile, portal embolization, enteral nutrition, and so on[3]. The widespread use of liver resection (above 80% in the most recent series), resection of segment I, venous resection (performed in 6%-43% of patients), arterial resection, and the non-touch technique have improved survival for many reasons, but above all because they allow an increase in R0 resections.

Prof. Serrablo et al[9] have resumed surgical outcomes in HC: All these technical improvements have been achieved without significantly increasing morbidity and mortality[1-3]; mortality in HC surgery currently ranges between 0% and 11.9%[3,5].

Prof. Castellano-Megías et al[10] have reviewed the importance of an adequate and minucius pathologic study of surgical specimens in HC.

Dra. Ramírez-Merino et al[11] have updated the role of adjuvant treatment in HC: There have been advances in chemotherapy used, brachytherapy, photodynamic therapy, and so on.

All the authors hope that this special issue answered every question about HC that readers need to be answered.

Footnotes

P- Reviewer Kapoor S S- Editor Zhai HH L- Editor A E- Editor Yan JL

References
1.  de Jong MC, Marques H, Clary BM, Bauer TW, Marsh JW, Ribero D, Majno P, Hatzaras I, Walters DM, Barbas AS. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer. 2012;118:4737-4747.  [PubMed]  [DOI]
2.  DeOliveira ML, Clavien PA. A common language to describe perihilar cholangiocarcinoma. Br J Surg. 2012;99:885-886.  [PubMed]  [DOI]
3.  Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129-140.  [PubMed]  [DOI]
4.  Nuzzo G, Giuliante F, Ardito F, Giovannini I, Aldrighetti L, Belli G, Bresadola F, Calise F, Dalla Valle R, D’Amico DF. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg. 2012;147:26-34.  [PubMed]  [DOI]
5.  Valls C, Ruiz S, Martinez L, Leiva D. Radiological diagnosis and staging of hilar cholangiocarcinoma. World J Gastrointest Oncol. 2013;5:115-126.  [PubMed]  [DOI]
6.  Rotellar F, Pardo F. Laparoscopic staging in hilar cholangiocarcinoma: Is it still justified? World J Gastrointest Oncol. 2013;5:127-131.  [PubMed]  [DOI]
7.  Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, Perez-Daga JA, Garcia-Albiach B, Pulido-Roa Y, Marin-Camero N, Santoyo-Santoyo J. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastroientest Oncol. 2013;5:132-138.  [PubMed]  [DOI]
8.  Ramos E. Principles of surgical resection in hilar cholangiocarcinoma. World J Gastroientest Oncol. 2013;5:139-146.  [PubMed]  [DOI]
9.  Serrablo A, Tejedor L. Outcome of surgical resection in Klatskin tumors. World J Gastrointest Oncol. 2013;5:147-158.  [PubMed]  [DOI]
10.  Castellano-Megías VM, Ibarrola-de Andrés C, Colina-Ruizdelgado F. Pathological aspects of so called "hilar cholangiocarcinoma". World J Gastrointest Oncol. 2013;5:159-170.  [PubMed]  [DOI]
11.  Ramírez-Merino N, Aix SP, Cortés-Funes H. Chemotherapy for cholangiocarcinoma: An update. World J Gastrointest Oncol. 2013;5:171-176.  [PubMed]  [DOI]