Perihilar cholangiocarcinoma. Surgical diagnosis and treatment

Abstract

Introduction. Even though cholangiocarcinoma is a rare hepatobiliary malignancy, with an incidence of <1 case per 100,000 people, which represents 3% of all gastrointestinal malignancies worldwide, the patients with PHC are usually hospitalized with severe, painless jaundice and are diagnosed at an advanced stage, which means an unfavorable prognosis and a short life span. Preoperative diagnosis and available surgeries provide the opportunity to intervene promptly, respectively improving survival. Aim of study. The aim of the study is to compare staging, assess resectability and identify the diagnostic and therapeutic approach to perihilar cholangiocarcinoma. Methods and materials. A descriptive, retrospective study was carried out on a group of patients with Klatskin cholangiocarcinoma. Between 2020 and 2023, 17 patients were admitted to the surgery clinic of "Timofei Moșneaga" IMSP SCR* (*Public Medical-sanitary Institution Republican Clinical Hospital "Timofei Mosneaga"). The research of the study was based on the statistical method accompanied by clinical, paraclinical examination including laboratory tests and instrumental investigations (necessary for tumor localization, pre-surgical staging and resectability identification). Non-invasive (ultrasonography, CT, MRCP), and invasive (CPGRE) diagnostic methods are used. The parameters evaluated were as follows: tumor staging, technical variants applied. Results. According to the Bismuth - Corlette classification, Klatskin tumors type I and II – 2 cases, type IIIA – 3 cases, IIIB – 2, and 10 cases were recorded in type IV. Surgical treatment was performed in 7 (41.1%) patients. Left hepatectomy was performed in 2 patients, right hepatectomy in 2 patients with restoration of digestive tract continuity by applying hepatico-jejunal anastomosis in Y a la Roux and extension to the caudate lobe. In the other 3 cases, resection of the main bile ducts was used with the application of bi hepatico-jejunal anastomosis. Conclusion. The examination algorithm for patients with Klatskin tumors will include – clinical examination, laboratory and instrumental examination. Ultrasound, CT, MRCP and CPGRE shall be used as a choice). Due to the aggressive nature of the Klatskin tumor and the late onset of symptoms, only 41.1% of patients are surgically resectable at diagnosis. Surgery is the only curative option, but long-term survival is reduced. incidence of <1 case per 100,000 people, which represents 3% of all gastrointestinal malignancies worldwide, the patients with PHC are usually hospitalized wi th severe, painless jaundice and are diagnosed at an advanced stage, which means an unfavorable pr ognosis and a short life span. Preoperative diagnosis and available surgeries provide the oppor tunity to intervene promptly, respectively improving survival. Aim of study. The aim of the study is to compare staging, assess resec tability and identify the diagnostic and therapeutic approach to perihilar cholangiocarc inoma. Methods and materials. A descriptive, retrospective study was carried out on a group of patients with Klatskin cholangiocarcinoma. Between 2020 and 2023, 17 pati ents were admitted to the surgery clinic of "Timofei Moșneaga" IMSP SCR* (*Public Me dical-sanitary Institution Republican Clinical Hospital "Timofei Mosneaga"). The r esearch of the study was based on the statistical method accompanied by clinical, paraclinical exa mination including laboratory tests and instrumental investigations (necessary for tumor localiz ation, pre-surgical staging and resectability identification). Non-invasive (ultrasonography, CT, MRCP), and invasive (CPGRE) diagnostic methods are used. The parameters evaluated were as follows : tumor staging, technical variants applied. Results. According to the Bismuth - Corlette classification, Klatskin tumors type I and II – 2 cases, type IIIA – 3 cases, IIIB – 2, and 10 cases were recorded in t ype IV. Surgical treatment was performed in 7 (41.1%) patients. Left hepatectomy was performed in 2 patients, right hepatectomy in 2 patients with restoration of digestive tract continui ty by applying hepatico-jejunal anastomosis in Y a la Roux and extension to the caudate lobe. In the other 3 cases, resection of the main bile ducts was used with the application of bi hepatico-jejunal an astomosis. Conclusion. The examination algorithm for patients with Klatskin tumors will include – clinical examination, laboratory and instrumental examination. Ultr asound, CT, MRCP and CPGRE shall be used as a choice). Due to the aggressive nature of the Kla tskin tumor and the late onset of symptoms, only 41.1% of patients are surgically resectable at diagnosis. Surgery is the only curative option, but long-term survival is reduced.