Background: Surgical therapy still offers the only chance of long-term survival for patients with perihilar cholangiocarcinoma (pCCA). The aim of this narrative review is to summarize the current standards and challenges in the surgical treatment of pCCA. Summary: After imaging and defining resectability, the first step towards optimal surgical treatment is optimizing biliary drainage and preventing cholangitis, followed by securing adequate future liver remnant volume and/or function. The main goal of resection for pCCA is achieving radical resection and ultimately long-term survival. In order to achieve radical resection, several points will be addressed (e.g., vascular resection and reconstruction, intraoperative frozen sections, right versus left hemihepatectomy, and the usefulness of preoperative [chemo]therapy). Key Messages: In order to optimize long-term outcomes for patients with pCCA, collaboration between leading centers should be increased. In addition, this collaboration is necessary to design large prospective randomized controlled trials, as the incidence of pCCA is low and the number of resectable patients is even lower. Currently, most results are based on small retrospective cohort studies resulting in low evidence. In order to properly investigate how to improve long-term survival, we need to set up trials to confirm the results of small series suggesting the positive effect of preoperative chemotherapy and extended lymph node resection.
Visc Med

中文翻译：

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肝门周围胆管癌的手术治疗：最新技术


背景：手术治疗仍然是门周胆管癌（pCCA）患者长期生存的唯一机会。这篇叙述性综述的目的是总结 pCCA 手术治疗的当前标准和挑战。摘要：在成像和确定可切除性之后，实现最佳手术治疗的第一步是优化胆道引流和预防胆管炎，然后确保未来有足够的残余肝脏体积和/或功能。 pCCA切除的主要目标是实现根治性切除并最终实现长期生存。为了实现根治性切除，需要解决几个问题（例如，血管切除和重建、术中冰冻切片、右半肝切除术与左半肝切除术以及术前化疗的有效性）。关键信息：为了优化 pCCA 患者的长期预后，应加强领先中心之间的合作。此外，这种合作对于设计大型前瞻性随机对照试验是必要的，因为 pCCA 的发生率较低，可切除的患者数量甚至更低。目前，大多数结果都是基于小型回顾性队列研究，导致证据不足。为了正确研究如何提高长期生存率，我们需要开展试验来证实小系列研究的结果，表明术前化疗和扩大淋巴结切除术的积极作用。
 内脏医学