Diagnóstico E Intervenções Curativas E Paliativas Do Colangiocarcinoma Hilar (Tumor De Klatskin)

Objetivos: Realizar um levantamento de dados da literatura acerca da epidemiologia, fatores de risco, quadro clínico de apresentação e intervenções curativas e paliativas para o colangiocarcinoma hilar ou Tumor de Klatskin. Métodos: A pesquisa foi realizada utilizando a fórmula de busca, elaborada a partir dos descritores “tumor de Klatskin”, “colangiocarcinoma hilar” e “colangiocarcinoma perihilar”, contidos no DeCS (Descritores em Ciências da Saúde) e correspondentes ao objetivo do estudo, e do operador booleano “OR”. A fórmula foi inserida na base de dados PubMed e a busca resultou em um total de 37 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram selecionados 10 artigos para compor a revisão. Resultados: Dos estudos incluídos, 10% (n=1) deles expôs a epidemiologia e fatores de risco associados ao tumor de Klatskin, 20% (n=2) abordaram sobre o diagnóstico, 40% (n=4) discorreram sobre a drenagem biliar paliativa ou adjuvante, 20% (n=2) discutiram sobre a ressecção com intenção curativa e 10% (n=1) sobre o transplante de fígado para colangiocarcinoma hilar irressecável. O tumor de Klatskin foi o terceiro tipo mais frequente dentre os tumores hepatobiliopancreáticos. Os sintomas e sinais mais comuns de apresentação foram icterícia, perda ponderal e dor abdominal. As ressecções de intenção curativa realizadas mais recentemente foram significativamente associadas a maior taxa de ressecabilidade e a maior sobrevida. Drenagem biliar transhepática percutânea com colocação de stent mostrou resultados satisfatórios e maior vantagem do que a via endoscópica. Conclusão: Diante das informações coletadas da literatura e explanadas nesta revisão, salienta-se a importância de médicos clínicos e cirurgiões conhecerem a epidemiologia, fatores de risco associados e os sinais e sintomas de apresentação do colangiocarcinoma hilar, além das técnicas, indicações e resultados dos tratamentos curativos e paliativos, para que possam reconhecer, diagnosticar e intervir em tempo oportuno, no intuito de elevar a sobrevida e garantir a melhor qualidade de vida possível ao paciente.

Mixed adenoneuroendocrine carcinoma of the hepatic bile duct: a case report and review of the literature

Background The World Health Organization's updated classification of digestive system neuroendocrine tumors in 2010 first proposed the classification of mixed adenoneuroendocrine carcinoma (MANEC). The incidence of biliary malignant tumors with neuroendocrine tumors accounts for less than 1% of all neuroendocrine tumors. Moreover, the incidence of hilar bile duct with MANEC is very rare. Case presentation A 65-year-old female patient came to our hospital for repeated abdominal pain for more than 4 months and skin sclera yellow staining for 1 week. Contrast-enhanced computed tomography imaging and magnetic resonance results suggested a hilar tumor for Bismuth-Corlette Type II. The patient underwent radical surgery for hilar cholangiocarcinoma. Finally, the patient was diagnosed with hilar bile duct MANEC, staged 1 (pT1N0M0) based on the eighth edition of the AJCC. Histopathology showed that the tumor was a biliary tumor with both adenocarcinoma and neuroendocrine carcinoma. No evidence of recurrence and metastasis after 20 months of follow-up. Conclusions We first reported a MANEC that originated in the hilar bile duct. As far as we known, there were few reports of biliary MANEC, and the overall prognosis was poor. We also found that the higher the Ki-67 index, the worse the prognosis of this type of patient. Radical surgery is the most effective treatment.

Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results

Purpose: The retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses additional surgical challenge due to the special location and poor tumor exposure. We developed a novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN, and evaluated its efficacy in a retrospective case-control comparative .Methods: From March 2016 to April 2019, a total of 39 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique, which improved the tumor exposure by opening the peritoneum and rotating the kidney ventrally, was applied in 24 cases and the conventional RAPN was performed in the other 15 cases (control group). Perioperative data was analyzed to evaluate the efficacy of the kidney ventrally rotation technique.Results: In kidney rotation group, the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The warm ischemia time was 17.4 ± 6.6 min, which was significantly shorter than 24.5 ± 8.3 min in control group. The mean operation time (80 ± 24 min) and estimated blood loss (104 ± 65 ml) were not different from control group. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases.Conclusion: Kidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient option for the management of posterior hilar tumor.

Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results

Purpose: The retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses additional surgical challenge due to the special location and poor tumor exposure. A novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN was developed, and its efficacy was assessed in a consecutive case series.Methods: From April 2017 to April 2019, a total of 24 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique was applied in all these cases, which specialized in improving the exposure of posterior hilar tumor by rotating the kidney ventrally. Perioperative data was analyzed to evaluate the efficacy of this technique.Results: The mean tumor size was 4.3 ± 1.7 cm (range 2.5-8 cm), and the median R.E.N.A.L score was 9 (range 7-12). All the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The mean operation time was 80 ± 24 min, the mean estimated blood loss was 104 ± 65 ml, and the warm ischemia time was 17.4 ± 6.6 min. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases.Conclusion: Kidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient method for the management of posterior hilar tumor.KEYWORDS: robotic surgery; partial nephrectomy; posterior hilar tumor; retroperitoneal approach; kidney rotation