Palliation: Hilar cholangiocarcinoma

被引:29
作者
Goenka, Mahesh Kr [1 ]
Goenka, Usha [2 ]
机构
[1] Apollo Gleneagles Hosp, Inst Gastro Sci, 58 Canal Circular Rd, Kolkata 700054, India
[2] Apollo Gleneagles Hosp, Dept Imaging & Intervent Radiol, Kolkata 700054, India
关键词
Cholangiocarcinoma; Hilar cholangiocarcinoma; Klatskin's tumor; Palliation; Biliary stenting;
D O I
10.4254/wjh.v6.i8.559
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography (ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous biliary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hilar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as a segment. bypass if, during a laparotomy for resection, the tumor is found to be unresectable. Photodynamic therapy and, more recently, radiofrequency ablation have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the biliary involvement (Bismuth class) and the availability of local expertise. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
引用
收藏
页码:559 / 569
页数:11
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