Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

Conversion treatment for advanced intrahepatic cholangiocarcinoma: Opportunities and challenges

The prevalence of intrahepatic cholangiocarcinoma (ICC) is increasing globally. Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades, the prognosis for ICC remains poor. Owing to the high degree of malignancy and insidious onset of ICC, numerous cases are detected at intermediate or advanced stages of the disease, hence eliminating the chance for surgical intervention. Moreover, because of the highly invasive characteristics of ICC, recurrence and metastasis postresection are prevalent, leading to a 5-year survival rate of only 20%-35% following surgery. In the past decade, different methods of treatment have been investigated, including transarterial chemoembolization, transarterial radioembolization, radiotherapy, systemic therapy, and combination therapies. For certain patients with advanced ICC, conversion treatment may be utilized to facilitate surgical resection and manage disease progression. This review summarizes the definition of downstaging conversion treatment and presents the clinical experience and evidence concerning conversion treatment for advanced ICC.

The benefits of an offline to online cognitive behavioral stress management regarding anxiety, depression, spiritual well-being, and quality of life in postoperative intrahepatic cholangiocarcinoma patients

AIM

Cognitive behavioral stress management (CBSM) has been introduced for the postoperative cancer management, but its application in intrahepatic cholangiocarcinoma (ICC) is rare. This current study constructed an offline to online CBSM (OO-CBSM) program and applying multiple assessing scales, aiming at exploring the benefits of OO-CBSM regarding anxiety, depression, spiritual well-being, and quality of life (QoL) in postoperative ICC patients.

METHODS

The study randomly assigned 68 postoperative ICC patients into OO-CBSM (N = 34) and normal care (NC) (N = 34) groups to undergo 10-week interventions. Hospital anxiety-and-depression scale (HADS), Zung's self-reporting anxiety scale (SAS), and depression scale (SDS), functional-assessment of chronic-illness therapy-spiritual well-being scale (FACIT-Sp), European quality-of-life-5 dimensions (EQ-5D), and quality-of-life questionnaire-core30 (QLQ-C30) were assessed within 6 months (M).

RESULTS

HADS-anxiety scores at M3 (P = 0.049) and M6 (P = 0.009), SAS score at M6 (P = 0.028), HADS-depression score at M3 (P = 0.043), and SDS scores at M3 (P = 0.044) and M6 (P = 0.028), were lower in the OO-CBSM group versus the NC group. Meanwhile, FACIT-Sp scores at M1 (P = 0.042) and M6 (P = 0.003) were higher in the OO-CBSM group over the NC group. Besides, EQ-5D scores at M3 (P = 0.067) and M6 (P = 0.087) disclosed trends to be lower in the OO-CBSM group versus the NC group, but not statistically significant. QLQ-C30-global-health scores at M3 (P = 0.049) and M6 (P = 0.033), and QLQ-C30-function score at M6 (P = 0.046), were higher in OO-CBSM group over NC group; but QLQ-C30-symptom score was not significantly different at any timepoints between them.

CONCLUSION

OO-CBSM attenuates anxiety and depression, and advances spiritual well-being and QoL in postoperative ICC patients, indicating its potency for the ICC postoperative management.

Ultrasound-guided percutaneous transhepatic biliary drainage for distal biliary malignant obstructive jaundice

The main cause of distal biliary malignant obstructive jaundice (DBMOJ) is the stricture of the extrahepatic biliary tract by malignant tumors, including pancreatic head and uncinate process cancer, low-grade cholangiocarcinoma, duodenal cancer, papillary duodenal cancer and other malignant tumors. The most effective treatment is radical pancreaticoduodenectomy. However, preoperative obstructive jaundice can affect the patient's liver function and blood coagulation function, increase local inflammation and oedema, and make surgery more difficult. Patients with severe obstructive jaundice require preoperative biliary drainage, which can be achieved by various methods, including ultrasound endoscopic biliary drainage (EUS-EBD) and endoscopic retrograde biliary drainage (ERBD). The latter is mainly divided into endoscopic nasobiliary drainage and endoscopic biliary stent. Some patients underwent percutaneous transhepatic biliary drainage (PTBD) when ERBD and EUS-EBD failed. In this study, we aimed to identify PTBD in DBMOJ and to further investigate the role of the puncture pathway in DBMOJ. The relationship between PTBD and bile duct internal diameter was confirmed by analysing and collating clinical data. In this study, DBMOJ was grouped according to bile duct internal diameter and liver function was used as an indicator to examine the improvement in liver function with PTBD in patients undergoing DBMOJ. Analysis of puncture complications showed that PTBD puncture was safe. DBMOJ with different bile duct internal diameters had different rates of liver function improvement after PTBD. The right-side approaches had significantly lower alanine aminotransferase (ALT) and alanine transaminase (AST) than the left-side approaches. This study showed that PTBD for DBMOJ is associated with a low complication rate and good reduction of jaundice. Liver function recovery was faster in patients with DBMOJ treated with PTBD in the right-sided approach compared with the left-sided approach. PTBD is an effective tool to be used in patients who have failed ERBD and EUS-EBD.