Vascular Involvements in Cholangiocarcinoma: Tips and Tricks
Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA wi...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-07-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/13/15/3735 |
| _version_ | 1797525688828297216 |
|---|---|
| author | Roberta Angelico Bruno Sensi Alessandro Parente Leandro Siragusa Carlo Gazia Giuseppe Tisone Tommaso Maria Manzia |
| author_facet | Roberta Angelico Bruno Sensi Alessandro Parente Leandro Siragusa Carlo Gazia Giuseppe Tisone Tommaso Maria Manzia |
| author_sort | Roberta Angelico |
| collection | DOAJ |
| description | Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction. |
| first_indexed | 2024-03-10T09:17:29Z |
| format | Article |
| id | doaj.art-010e1fffaa8e42c2803e0017da59c8a9 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T09:17:29Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-010e1fffaa8e42c2803e0017da59c8a92023-11-22T05:26:56ZengMDPI AGCancers2072-66942021-07-011315373510.3390/cancers13153735Vascular Involvements in Cholangiocarcinoma: Tips and TricksRoberta Angelico0Bruno Sensi1Alessandro Parente2Leandro Siragusa3Carlo Gazia4Giuseppe Tisone5Tommaso Maria Manzia6Hepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, ItalyHepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, ItalyHepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, ItalyHepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, ItalyHepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, ItalyHepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, ItalyHepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, ItalyCholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.https://www.mdpi.com/2072-6694/13/15/3735cholangiocarcinomavascular involvementresectionvascular reconstructionliveroutcomes |
| spellingShingle | Roberta Angelico Bruno Sensi Alessandro Parente Leandro Siragusa Carlo Gazia Giuseppe Tisone Tommaso Maria Manzia Vascular Involvements in Cholangiocarcinoma: Tips and Tricks Cancers cholangiocarcinoma vascular involvement resection vascular reconstruction liver outcomes |
| title | Vascular Involvements in Cholangiocarcinoma: Tips and Tricks |
| title_full | Vascular Involvements in Cholangiocarcinoma: Tips and Tricks |
| title_fullStr | Vascular Involvements in Cholangiocarcinoma: Tips and Tricks |
| title_full_unstemmed | Vascular Involvements in Cholangiocarcinoma: Tips and Tricks |
| title_short | Vascular Involvements in Cholangiocarcinoma: Tips and Tricks |
| title_sort | vascular involvements in cholangiocarcinoma tips and tricks |
| topic | cholangiocarcinoma vascular involvement resection vascular reconstruction liver outcomes |
| url | https://www.mdpi.com/2072-6694/13/15/3735 |
| work_keys_str_mv | AT robertaangelico vascularinvolvementsincholangiocarcinomatipsandtricks AT brunosensi vascularinvolvementsincholangiocarcinomatipsandtricks AT alessandroparente vascularinvolvementsincholangiocarcinomatipsandtricks AT leandrosiragusa vascularinvolvementsincholangiocarcinomatipsandtricks AT carlogazia vascularinvolvementsincholangiocarcinomatipsandtricks AT giuseppetisone vascularinvolvementsincholangiocarcinomatipsandtricks AT tommasomariamanzia vascularinvolvementsincholangiocarcinomatipsandtricks |