Cholangiocarcinoma (CCA) poses a substantial threat as it ranks as the second most prevalent primary liver tumor. The documented annual rise in intrahepatic CCA (iCCA) incidence in the United States is concerning, indicating its growing impact. Moreover, the five-year survival rate after tumor resection is only 25%, given that tumor recurrence is the leading cause of death in 53–79% of patients. Pre-operative assessments for iCCA focus on pinpointing tumor location, biliary tract involvement, vascular encasements, and metastasis detection. Numerous studies have revealed that portal vein embolization (PVE) is linked to enhanced survival rates, improved liver synthetic functions, and decreased overall mortality. The challenge in achieving clear resection margins contributes to the notable recurrence rate of iCCA, affecting approximately two-thirds of cases within one year, and results in a median survival of less than 12 months for recurrent cases. Nearly 50% of patients initially considered eligible for surgical resection in iCCA cases are ultimately deemed ineligible during surgical exploration. Therefore, staging laparoscopy has been proposed to reduce unnecessary laparotomy. Eligibility for orthotopic liver transplantation (OLT) requires certain criteria to be granted. OLT offers survival advantages for early-detected unresectable iCCA; it can be combined with other treatments, such as radiofrequency ablation and transarterial chemoembolization, in specific cases. We aim to comprehensively describe the surgical strategies available for treating CCA, including the preoperative measures and interventions, alongside the current options regarding liver resection and OLT.
胆管癌（CCA）作为第二常见的原发性肝脏肿瘤，构成重大威胁。美国肝内胆管癌（iCCA）发病率逐年上升的记录令人担忧，表明其影响日益加剧。此外，由于肿瘤复发是53-79%患者的主要死因，肿瘤切除后的五年生存率仅为25%。iCCA的术前评估侧重于精确定位肿瘤位置、胆道受累情况、血管包绕及转移检测。大量研究表明，门静脉栓塞术（PVE）与提高生存率、改善肝脏合成功能及降低总体死亡率相关。实现清晰切除切缘的挑战导致iCCA显著的高复发率，约三分之二病例在一年内复发，且复发病例的中位生存期不足12个月。在iCCA病例中，近50%最初被认为适合手术切除的患者最终在手术探查中被判定为不适合。因此，建议采用分期腹腔镜检查以减少不必要的开腹手术。原位肝移植（OLT）的资格需满足特定标准。对于早期发现的不可切除iCCA，OLT可提供生存优势；在特定情况下，可联合射频消融和经动脉化疗栓塞等其他治疗手段。本文旨在全面阐述治疗CCA的手术策略，包括术前措施和干预手段，以及当前关于肝切除和OLT的可行方案。
Cholangiocarcinoma: The Current Status of Surgical Options including Liver Transplantation
肿瘤(癌症)患者之家