John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Surgical treatment of cholangiocarcinomas Volume 21, issue 8, Octobre 2014

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Authors
CHU de Rennes, hôpital Pontchaillou, service de chirurgie hépatobiliaire et digestive, 35033 Rennes Cedex, France
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Cholangiocarcinomas are malignant tumours arising from the epithelium of the biliary tract. Two different anatomical types exist: intrahepatic cholangiocarcinomas which are developed in the proximal small canaliculii, i.e. within the liver parenchyma, and perihilar cholangiocarcinomas which are located in the area of the hepatic hilum obstructing the biliary confluence.

Intrahepatic cholangiocarcinomas are usually discovered at a late stage when the tumor is large. The diagnosis is confirmed by percutaneous biopsy. Complete resection, whenever possible, offers the best chance for prolonged survival. Intra-arterial injection of Yttrium-90 microsphere combined with platinum salts based chemotherapy is a promising treatment to downstage the tumour and render resectable tumors that initially were not.

Perihilar cholangiocarcinomas are in close vicinity with vessels of the liver hilum, making the surgery difficult. Diagnosis and resectability are predicated on a set of CT scan and MRI signs. Surgery whenever possible is the best therapeutic option, however it is only possible after a long lasting preoperative optimization period which aims at improving the patient status and optimize the volume and function of the future remnant liver. Orthotopic liver transplantation is a highly efficient option in young patients with unresectable localized perihilar cholangiocarcinomas.