2. PERIHILAR CHOLANGIOCARCINOMA
• In the past two decades , with the advances in
diagnostic ,interventional imaging and surgical
techniques , many surgeons have adopted an
agressive approch to perihilar CC as surgical
resection is the only way to cure this intractable
disease .
• So the surgical outcomes and survival rates
have gradually improved .
3. PERIHILAR CHOLANGIOCARCINOMA
• Tumors located in the extra-hepatic biliiary tract
proximal to the origine of the cystic duct.
• Potentially include 2 types of tumors : one
arising from the large hilar bile duct and the
other with intrahepatic component and
secondary invasion of the porta hepatis.
9. CT / MRI
• The accuracy of CT and MRI with MRCP
for prediction of the extent of ductal
involvement ( 84-91 % ) , hepatic artery
and portal invasion (86 – 98 % ) ,hepatic
volumetry , lymph nodes and metastasis
( 74 – 84 % ) .
30. PORTAL VEIN EMBOLIZATION
• Now widely used in the presurgical
treatmentof patients undergoing an
extended hepatectomy to minimize the
post-operative liver dysfunction .
31. PORTAL VEIN EMBOLIZATION
• Can benefit patients requiring a future liver
remnant of 25 % of the total liver volume if
liver function is normal and 40 % if liver
function is compromised .
32.
33. BILIARY DRAINAGE
• Remain controversial
• Has provred to be beneficial in case of
cholangitis , severe malnutrion and
coagulation abnormalities .
• Absolutely indicated for patients requiring
major hepatic resection .
• Unilateral BD for future remnant lobe is
recommanded in B / C III and IV tumors .
38. STAGING / CLASSIFICATION
• Staging should ideally be performed before and
after surgery to include all inta-operative
informations and results from macroscopic and
microscopis examinations
39. STAGING / CLASSIFICATION
Systems most commonly used to evaluate PCH
• - Bismuth / Corlette
• - MSKCC ( Memorial Sloan-Kettering Cancer Center )
• - AJCC ( American Joint Commission on Cancer
Staging 7 th edition ) : TNM
• - EHPBA (European Hepato-Pancreato-Biliary
Association )
44. SURGERY
• Resectional procedures depend on the
location of the primary tumor.
• - Rigth hepatectomy is applied to B/C I ,II
and III a tumor.
• - Left hepatectomy to B/C IIIb .
45. SURGERY
• In B / C IV , the type of hepatectomy is
determined by considering the predominant
tumor location , the presence or absence of
portal vein or hepatic artery invasion and liver
function.
46. SURGERY
• In B / C IV
• - Right predominant tumor : right
trisectionectomy ( trisegmentectomy or
hight extensive hepatectomy ) 4,5,6,7,8+ 1
• - Left predominant : left trisectionectomy :
2,3,4,5,8 + 1
