Intrahepatic Cholangiocarcinoma Involving the Hepatocaval Confluence with Bile Duct Tumor Thrombus Mimicking a Klatskin Tumor: A Case Report (original) (raw)
Related papers
Two varieties of intrahepatic cholangiocarcinoma
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1994
Surgical treatment of intrahepatic cholangiocarcinoma: Four patients survioing more than five years. Surgery; 111:617-622 duct and hilar lymph nodal dissection is recommended for infiltrating ICC.
Current Surgical Management of Peri-Hilar and Intra-Hepatic Cholangiocarcinoma
Cancers, 2021
Cholangiocarcinoma accounts for approximately 10% of all hepatobiliary tumors and represents 3% of all new-diagnosed malignancies worldwide. Intrahepatic cholangiocarcinoma (i-CCA) accounts for 10% of all cases, perihilar (h-CCA) cholangiocarcinoma represents two-thirds of the cases, while distal cholangiocarcinoma accounts for the remaining quarter. Originally described by Klatskin in 1965, h-CCA represents one of the most challenging tumors for hepatobiliary surgeons, mainly because of the anatomical vascular relationships of the biliary confluence at the hepatic hilum. Surgery is the only curative option, with the goal of a radical, margin-negative (R0) tumor resection. Continuous efforts have been made by hepatobiliary surgeons in order to achieve R0 resections, leading to the progressive development of aggressive approaches that include extended hepatectomies, associating liver partition, and portal vein ligation for staged hepatectomy, pre-operative portal vein embolization, a...
Surgery, 2008
Background. Limited data exist regarding the role of extended liver resection for the management of intrahepatic cholangiocarcinoma (ICC), most of which derive from small single-center or larger multicenter series. In the current report, we present our experience with the surgical management of ICC, analyze operative results, and investigate prognostic factors in resected patients. Methods. A total of 72 patients underwent operative exploration for ICC between 1991 and 2005; 54 patients were resected, and 18 patients were deemed unresectable based on intraoperative findings. Demographics, pathology, anatomic characteristics, operative results, and survival were analyzed. Results. The resectability rate was 71%, with negative margins achieved in 78% of the resected patients. Extended liver resections were performed in 24 (44%) of the 72 patients. Perioperative mortality after resection was 7%, with 11% morbidity. The 1-, 3-and 5-year survival rates after resection were 80%, 49% and 25% ,respectively, and were significantly greater than for patients with unresectable disease (P < .001). R1 liver resections conferred increased 5-year survival compared with patients deemed unresectable (P = .03). None of the factors evaluated proved to be independent prognostic factors on multivariate analysis. Conclusions. R0 resection of ICC provides the best chance for prolonged survival, whereas R1 resection appears to be superior to nonoperative treatment. Declining operative mortality as a result of improved intraoperative and perioperative care justifies the performance of extended liver resections in these patients, although benefit has to be evaluated with respect to nodal involvement. (Surgery 2008;143: 366-74.) From the Recanati-Miller Transplantation Institute,
Intrahepatic Cholangiocarcinoma in a Cirrhotic Patient without Upstream Biliary Dilatation
Journal of Gastroenterology, Pancreatology & Liver Disorders
Intrahepatic cholangiocarcinoma (IHC) is a biliary tumor that arises from the intrahepatic bile ducts. It is the second most common primary hepatic malignancy after hepatocellular carcinoma (HCC), with higher prevalence in patients with cirrhosis and Hepatitis B and C. On imaging, IHC typically demonstrates progressive centripetal progression and significant delayed enhancement with dilatation of the bile ducts upstream from the tumor. We report a case of IHC in a cirrhotic patient which exhibited delayed enhancement but no evidence of upstream ductal dilatation. Due to differences between IHC and HCC in prognosis and treatment options, IHC should be considered in a cirrhotic patient when the hepatic tumor demonstrates delayed centripetal enhancement on CT and/or MR, even in the absence of upstream biliary dilatation.
Digestive diseases and sciences, 2015
A 67-year-old man was initially evaluated for progressive right upper quadrant pain of several months duration. He denied jaundice, acholic stools, nausea, vomiting, or pruritus. Past medical history included prostate cancer, cholelithiasis, appendicitis, hyperlipidemia, chronic lower back pain, mild hypertension, mild asthma, and gastroesophageal reflux disease. Past surgical history included prostatectomy, cholecystectomy, and appendectomy. Family history was remarkable for a brother with prostate cancer and a sister with breast cancer. The patient had a remote history of smoking and alcohol abuse. Physical examination revealed right upper quadrant tenderness but no hepatosplenomegaly. He had mild central obesity, but no stigmata of cirrhosis. Initial laboratory findings (complete blood count and comprehensive metabolic panel) were unremarkable. Computed tomography (CT) revealed a dominant 8.5-cm left-sided liver lesion with a satellite lesion measuring 3.7 cm. There was tumor thrombus into the left portal vein extending into the main portal vein (Fig. 1). Multiple enlarged regional lymph nodes were present in the porta hepatis and in the gastrohepatic ligament. Positron emission tomography (PET) displayed fluorodeoxyglucose (FDG) avidity in the liver
Intrahepatic cholangiocarcinoma: clinical aspects, pathology and treatment
HPB surgery : a world journal of hepatic, pancreatic and biliary surgery, 1992
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary tumor of the liver. To further define its clinicopathology and surgical management, we reviewed our experience. Clinical presentations of 32 patients with ICC was similar to that with hepatocellular carcinoma. Jaundice occurred in only 27 percent. ICC was unresectable due to advanced disease stage in 81 percent. Six patients had curative resections with two 5 year disease free survivors. Underlying liver disease was associated with ICC in 34 percent of patients.
In-continuity hepatic resection for advanced hilar cholangiocarcinoma
The American Journal of Surgery, 2004
The purpose of this study was to examine outcomes of patients undergoing concomitant hepatectomy and bile duct excision for advanced Klatskin tumors. Methods: Thirty-one patients, 16 men and 15 women, with an average age of 64 years, underwent concomitant biliary and hepatic resections for Klatskin tumors. Outcomes, including complications and survival, are reported. Results: Fifteen patients had postoperative courses free of complications. Sixteen patients experienced a total of 50 complications; 13 patients experienced 1 or more major complications (including hemorrhage [n ϭ 1], pneumonia [n ϭ 5], intra-abdominal abscess [n ϭ 8], hepatic failure [n ϭ 3], and myocardial infarction [n ϭ 2]). Five patients died perioperatively, 1 from adult respiratory distress syndrome and 4 from multisystem organ failure precipitated by hepatic failure. One-, 3-, and 5-year survival after resection was 69%, 33%, and 26%, respectively. American Joint Committee on Cancer stage and margin status did not impact long-term survival after resection. Conclusions: Concomitant hepatic and biliary resections for Klatskin tumors carry relatively high risk but offer hope for long-term survival. This study supports in-continuity hepatectomy and extrahepatic biliary resection for advanced Klatskin tumors even when microscopically negative margins cannot be obtained.
Surgical treatment of intrahepatic cholangiocarcinoma
Journal of Hepatology
iCCA pCCA dCCA What is it? Intrahepatic cholangiocarcinoma (iCCA) is a predominantly mass-forming and lymphophilic malignancy of the intrahepatic bile ducts. It is the second most common primary liver cancer after HCC. While relatively rare, incidence of iCCA is increasing. Intrahepatic Cholangiocarcinoma: A surgical perspective Neoadjuvant therapy Adjuvant therapy Liver Transplant (LT) Liver Resection (LR) Surgery Selection Major LR is the current mainstay for treatment for iCCA, though only 12-40% of patients referred are resectable. Overall survival at 5-years is 25-40%, and 50-70% face tumor recurrence. Characteristics are considered with the goal of balancing complete R0 resection and preservation of a sufficient future liver remnant (FLR). Perioperative technique is a focus for research to improve outcomes and increase resectability Liver transplant has become an area of interest for iCCA in recent years after which retrospective studies were conducted with more stringent selection criteria. One major study found a 5-year OS of 65% after transplantation for single tumors ≤2 cm. Advanced iCCA with neoadjuvant therapy is also considered.