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Kodali S, Connor AA, Brombosz EW, Ghobrial RM. Update on the Screening, Diagnosis, and Management of Cholangiocarcinoma. Gastroenterol Hepatol (N Y) 2024; 20:151-158. [PMID: 38680168 PMCID: PMC11047158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Cholangiocarcinoma (CCA) is a neoplasm of the biliary tract that has become increasingly prevalent throughout the world. Common risk factors for developing CCA include cirrhosis, primary sclerosing cholangitis, and trematode fluke infestation, although there are no set screening guidelines in high-risk groups. Lesions are typically identified via cross-sectional imaging and/or elevated serum carbohydrate antigen 19-9 levels, often followed by cytology or brushings with fluorescence in situ hybridization for confirmation. Treatments can vary among CCA subtypes but frequently involve systemic therapies such as gemcitabine and cisplatin with durvalumab or pembrolizumab. Targeted therapies may also be effective (eg, ivosidenib, pemigatinib, infigratinib, futibatinib) depending on the molecular alterations present. Resection is the most common surgical treatment for CCA, although liver transplantation is also an option in highly selected patients with liver-limited unresectable disease. Radiotherapy may also be a treatment option, as well as transarterial radioembolization (eg, yttrium-90), which is often utilized in combination with systemic therapy. Although patients with CCA have traditionally had a poor prognosis, recent advances in treatment, including new systemic therapies and increased utilization of liver transplantation, have improved expected survival. This article reviews screening modalities, pros and cons of diagnostic techniques, and therapies that are currently available to treat patients with CCA.
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Affiliation(s)
- Sudha Kodali
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, J. C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ashton A. Connor
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, J. C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | | | - R. Mark Ghobrial
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, J. C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
- Department of Surgery, Weill Cornell Medical College, New York, New York
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Requeijo C, Bracchiglione J, Meza N, Acosta-Dighero R, Salazar J, Santero M, Meade AG, Quintana MJ, Rodríguez-Grijalva G, Selva A, Solà I, Urrútia G, Bonfill Cosp X. Anticancer Drugs Compared to No Anticancer Drugs in Patients with Advanced Hepatobiliary Cancer: A Mapping Review and Evidence Gap Map. Clin Epidemiol 2023; 15:1069-1085. [PMID: 38025841 PMCID: PMC10644842 DOI: 10.2147/clep.s431498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Despite being commonly recommended, the impact of anticancer drugs (ACDs) on patient-important outcomes beyond survival for advanced hepatobiliary cancers (HBCs) may not have been sufficiently assessed. We aim to identify and map the evidence regarding ACDs versus best supportive care (BSC) for advanced HBCs, considering patient-centered outcomes. Methods In this mapping review, we included systematic reviews, randomized controlled trials, quasi-experimental, and observational studies comparing ACDs (chemotherapy, immunotherapy, biological/targeted therapy) versus BSC for advanced HBCs. We searched MEDLINE (PubMed), EMBASE (Ovid), Cochrane Library, Epistemonikos, PROSPERO and clinicaltrials.gov for eligible studies. Two reviewers performed the screening and data extraction processes. We developed evidence maps for each type of cancer. Results We included 87 studies (60 for advanced liver cancer and 27 for gallbladder or bile duct cancers). Most of the evidence favored ACDs for survival outcomes, and BSC for toxicity. We identified several evidence gaps for non-survival outcomes, including quality of life or quality of end-of-life care. Discussion Patient-important outcomes beyond survival in advanced HBCs are insufficiently assessed by the available evidence. Future studies need to address these gaps to better inform decision-making processes.
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Affiliation(s)
- Carolina Requeijo
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Javier Bracchiglione
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Interdisciplinary Centre for Health Studies (CIESAL), Valparaiso University, Viña del Mar, Chile
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Nicolás Meza
- Interdisciplinary Centre for Health Studies (CIESAL), Valparaiso University, Viña del Mar, Chile
| | - Roberto Acosta-Dighero
- Interdisciplinary Centre for Health Studies (CIESAL), Valparaiso University, Viña del Mar, Chile
| | - Josefina Salazar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marilina Santero
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Adriana-G Meade
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - María Jesús Quintana
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | | | - Anna Selva
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari, Parc Taulí Research and Innovation Institute Foundation (I3PT-CERCA), Autonomous University of Barcelona, Sabadell, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Gerard Urrútia
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Xavier Bonfill Cosp
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - On behalf of Appropriateness of Systemic Oncological Treatments for Advanced Cancer (ASTAC) Research Group
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Interdisciplinary Centre for Health Studies (CIESAL), Valparaiso University, Viña del Mar, Chile
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari, Parc Taulí Research and Innovation Institute Foundation (I3PT-CERCA), Autonomous University of Barcelona, Sabadell, Spain
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Gasque RA, Zaietta N, Del Bueno ML, Saenz J, Chahdi Beltrame M, Quiñonez EG, Mattera FJ. [Primary neuroendocrine tumor of the common bile duct]. Rev Fac Cien Med Univ Nac Cordoba 2023; 80:141-144. [PMID: 37402297 PMCID: PMC10443413 DOI: 10.31053/1853.0605.v80.n2.40368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/07/2023] [Indexed: 07/06/2023] Open
Abstract
Primary neuroendocrine tumors (NETs) of the bile duct are extremely rare and represent only 0.2-2% of all gastrointestinal NETs. Within the biliary system, the main bile duct is the most affected site. A 28-year-old man with a 6-month history of intermittent jaundice, pruritus, and choluria. MRCP, PET-CT and endoscopic ultrasound were performed. A well-differentiated neuroendocrine neoplasia was diagnosed. Complete resection of the main bile duct was performed with lymphadenectomy of the hepatic pedicle with Roux-en-Y hepaticojejunostomy, without complications. The patient had an adequate evolution and nowadays he’s disease-free. Primary neuroendocrine tumors of the bile duct are extremely rare. They may present clinically and radiologically similar to perihilar cholangiocarcinoma, which makes preoperative diagnosis difficult. Radical resection is indicated. Usually, they are well differentiated tumors, being the Ki-67 labeling index a reliable prognostic marker.
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Affiliation(s)
| | - Noelia Zaietta
- Unidad de Cirugía hepatobiliar compleja, pancreática y trasplante hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina.
| | - María Luján Del Bueno
- Unidad de Cirugía hepatobiliar compleja, pancreática y trasplante hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina.
| | - Julieta Saenz
- Servicio de Anatomía Patológica, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina.
| | - Magalí Chahdi Beltrame
- Unidad de Cirugía hepatobiliar compleja, pancreática y trasplante hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina.
| | - Emilio Gastón Quiñonez
- Unidad de Cirugía hepatobiliar compleja, pancreática y trasplante hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina.
| | - Francisco Juan Mattera
- Unidad de Cirugía hepatobiliar compleja, pancreática y trasplante hepático, Hospital de Alta Complejidad en Red "El Cruce", Florencio Varela, Buenos Aires, Argentina.
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Lluís N, Serradilla-Martín M, Achalandabaso M, Jehaes F, Dasari BV, Mambrilla-Herrero S, Sparrelid E, Balakrishnan A, Hoogwater FJ, Amaral MJ, Andersson B, Berrevoet F, Doussot A, López-López V, Alsammani M, Detry O, Domingo-del Pozo C, Machairas N, Pekli D, Alcázar-López CF, Asbun H, Björnsson B, Christophides T, Díez-Caballero A, Francart D, Noel CB, Sousa-Silva D, Toledo-Martínez E, Tzimas GN, Yaqub S, Cauchy F, Prieto-Calvo M, D’Souza MA, Spiers HV, van den Heuvel MC, Charco R, Lesurtel M, Ramia JM. Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study). Int J Surg 2023; 109:760-771. [PMID: 36917142 PMCID: PMC10389541 DOI: 10.1097/js9.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND/PURPOSE Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. METHODS A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. RESULTS A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 ( P =0.016), intrahepatic versus extrahepatic tumor ( P =0.027), single versus multiple tumors ( P =0.007), those who underwent hepatic versus pancreatic resection ( P =0.017), or achieved versus failed TO ( P =0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P =0.03) was an independent prognostic factor of poor overall survival. CONCLUSIONS Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.
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Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Miguel Servet University Hospital, Zaragoza
| | - Mar Achalandabaso
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - François Jehaes
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Bobby V.M. Dasari
- Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Ernesto Sparrelid
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Anita Balakrishnan
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Frederik J.H. Hoogwater
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria J. Amaral
- Department of General Surgery, Centro Hospitalar e Universitário de Coimbra
- Faculty of Medicine, University of Coimbra, Coimbra
| | - Bodil Andersson
- Department of Surgery, Lund University
- Skane University Hospital, Lund
| | - Frederik Berrevoet
- Department of General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, Besancon
| | - Víctor López-López
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, Murcia
| | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege
| | | | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Cándido F. Alcázar-López
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thalis Christophides
- General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
| | | | - David Francart
- Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
| | - Colin B. Noel
- HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, Bloemfontein
| | - Donzília Sousa-Silva
- Department of Surgery, HEBIPA – Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Enrique Toledo-Martínez
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - George N. Tzimas
- Hepatobiliary Surgery Department, Hygeia Hospital, Athens, Greece
| | - Sheraz Yaqub
- Department of HPB Surgery, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Mikel Prieto-Calvo
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao
| | - Melroy A. D’Souza
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Harry V.M. Spiers
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Marius C. van den Heuvel
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ramón Charco
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - José M. Ramia
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
- Miguel Hernández University, Alicante
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Nghiem V, Wood S, Ramachandran R, Williams G, Outlaw D, Paluri R, Kim YI, Gbolahan O. Short- and Long-Term Survival of Metastatic Biliary Tract Cancer in the United States From 2000 to 2018. Cancer Control 2023; 30:10732748231211764. [PMID: 37926828 PMCID: PMC10668577 DOI: 10.1177/10732748231211764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/05/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Information about survival outcomes in metastatic biliary tract cancer (BTC) is sparse, and the numbers often quoted are based on reports of clinical trials data that may not be representative of patients treated in the real world. Furthermore, the impact of more widespread adoption of a standardized combination chemotherapy regimen since 2010 on survival is unclear. METHODS We performed an analysis of the Surveillance, Epidemiology, and End Results database to determine the real-world overall survival trends in a cohort of patients with metastatic BTC diagnosed between the years 2000 and 2017 with follow-up until 2018. We analyzed data for the entire cohort, evaluated short-term and long-term survival rates, and compared survival outcomes in the pre-2010 and post-2010 periods. Survival analysis was performed using the Kaplan-Meier method, and Cox proportional hazard models were used to evaluate factors associated with survival. RESULTS Among 13, 287 patients, the median age was 68 years. There was a preponderance of female (57%) and white (77%) patients. Forty-one percent died within 3 months of diagnosis (short-term survivors) and 20% were long-term survivors (12 months or longer). The median overall survival (OS) for the entire cohort was 4.5 months. Median OS improved post-2010 (4.5 months) compared to pre-2010 (3.5 months) (P < .0001). On multivariate analysis, age <55 years, intrahepatic cholangiocarcinoma, surgical resection, and diagnosis post-2010 were associated with lower hazard of death. CONCLUSION The real-world prognosis of metastatic BTC is remarkably poorer than described in clinical trials because a large proportion of patients survive less than three months. Over the last decade, the improvement in survival has been minimal.
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Affiliation(s)
- Van Nghiem
- University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Sarah Wood
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rekha Ramachandran
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Grant Williams
- Division of Hematology/Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Darryl Outlaw
- Division of Hematology/Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ravikumar Paluri
- Section of Hematology/Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Young-il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Olumide Gbolahan
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Seeherunwong A, Chaiear N, Khuntikeo N, Ekpanyaskul C. Cholangiocarcinoma Attributed to Occupation: A Systematic Reviews. Asian Pac J Cancer Prev 2022; 23:1837-1845. [PMID: 35763622 PMCID: PMC9587819 DOI: 10.31557/apjcp.2022.23.6.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 11/25/2022]
Abstract
Background: The occurrence of a cluster of occupational cholangiocarcinoma(CCA) cases among Japanese workers at a small offset printing plant led to the hypotheses that occupational exposure was the root cause of this cancer. Numerous workplace carcinogens can be found at various jobs sites and are integral to various industrial processes. Therefore, a systematic evaluation of potential occupationally-related CCA and likely exposure types is needed. Objective: To conduct a systematic review on the cause of CCA in relation to occupation. Methods: The systematic review included papers published between 1980 and 2020. Databases included PubMed, Science Direct, CINAHL, ProQuest Medical Library, Springer, Wiley online library, and the Cochrane library. The review focused on CCA, intrahepatic CCA(as distinct from other types of liver cancer), and extrahepatic CCA(not including the gallbladder). While some occupations involve an expected risk of exposure to carcinogens, this study sought both primary reports on specific carcinogens or surrogates by occupation or industry title. Of the 65 English version abstracts, 18 studies were selected for in-depth review according to the eligibility criteria. Two occupational physicians independently assessed the relevance to the study objectives, data extractability, and data quality as per the Newcastle-Ottawa Scale. Results: The review revealed that ten observational studies met the eligibility criteria. There was heterogeneity of occupational exposure assessment and the reported results. The possible carcinogens statistical significantly related to the incidence or mortality of CCA risk included 1,2-dichloropropane (the highest RR = 32.40, 95%CI=6.40-163.90), asbestos (the highest OR=4.81, 95 % CI =1.73–13.33), endocrine-disrupting compounds (the highest OR =2.00, 95% CI=1.10–3.70), and rotating shift work (the highest HR =1.97, 95%CI=1.02-3.79). These carcinogens are classified as IARC class 1 and 2A. Conclusions: Despite the limited number of studies reviewed, the hypothesis of occupational risk for CCA was supported. Occupational health and safety measures may decrease exposure to these carcinogens, and surveillance in high-risk occupations or industries is urgently needed to prevent and control CCA.
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Affiliation(s)
- Annantapat Seeherunwong
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Naesinee Chaiear
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narong Khuntikeo
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatchai Ekpanyaskul
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
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Hirao M, Hosui A, Mimura A, Ohnishi K, Tanimoto T, Okahara T, Sueyoshi Y, Goto T, Yamada T, Hiramatsu N. Significance of in vitro photodynamic cytodiagnosis with 5-aminolevulinic acid in biliary brush cytology for malignant biliary stricture. Photodiagnosis Photodyn Ther 2022; 38:102756. [PMID: 35150900 DOI: 10.1016/j.pdpdt.2022.102756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND For the early diagnosis of malignant biliary stricture due to biliary-pancreatic carcinoma, conventional biliary brush cytology with endoscopic retrograde cholangiopancreatography (ERCP; the conventional method) is not sensitive enough. METHODS Two hundred nine patients with biliary stricture who were admitted between September 2015 and June 2020 were enrolled in this study. Biliary brush cytology was performed on all patients. Samples were diagnosed independently by an expert pathologist and medical doctor with conventional cytology and photodynamic diagnosis (PDD) with 5-aminolevulinic acid. RESULTS The definitive diagnoses were 49 benign and 160 malignant diseases. The conventional method had a sensitivity of 77.5% (124/160) and specificity of 100% (49/49). The PDD method had a sensitivity of 77.5% (124/160) and specificity of 67.3% (33/49). The conventional method identified 36 malignant diseases as false negatives, while the PDD method enabled successful diagnoses of malignant diseases in 19 of these 36 patients. When PDD was combined with the conventional method, the sensitivity significantly increased to 89.4% (143/160, P=0.006), and for biliary tract diseases only, the sensitivity increased to 95.6% (88/92, P=0.001). CONCLUSIONS Malignant biliary stricture can be diagnosed effectively and safely with the in vitro PDD method. The sensitivity could be further increased by combining PDD with the conventional method.
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Affiliation(s)
- Motohiro Hirao
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka.
| | - Atsushi Hosui
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka
| | - Akihiro Mimura
- Department of Pathology, Osaka Rosai Hospital, Sakai, Osaka
| | - Kohsaku Ohnishi
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka
| | - Takashi Tanimoto
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka
| | - Toru Okahara
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka
| | - Yuka Sueyoshi
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka
| | - Takayoshi Goto
- Department of Pathology, Osaka Rosai Hospital, Sakai, Osaka
| | - Takuya Yamada
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka
| | - Naoki Hiramatsu
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka
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Kim EY, Hong TH. Changes in natural killer cell activity after surgery and predictors of its recovery-failure. J Surg Oncol 2021; 124:1561-1568. [PMID: 34351633 DOI: 10.1002/jso.26636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the changes in natural killer cell activity (NKA) during the entire treatment period of patients with resectable biliopancreatic cancers and investigated the predictors of the failure of recovery of NKA after surgery. METHODS A total of 202 patients who underwent curative resection for biliopancreatic cancer were enrolled in the study. NKA levels were measured six times during the treatment period. We investigated whether there was any difference in postoperative NKA recovery according to the period-by-time NKA value. RESULTS NKA decreased after surgery (mean, 40 pg/ml) compared to the NKA value at admission (200.2 pg/ml), then began to increase from 3 weeks after surgery (139.7 pg/ml) and rose to normal NKA levels at 5 weeks (217.1 pg/ml). The pattern of NKA changes was distinct according to the NKA values at admission. In multivariate analysis, NKA values of less than 250 pg/ml at admission (odds ratio = 5.898, p = 0.044) were a predictor of NKA recovery failure 5 weeks after surgery. CONCLUSIONS NKA rapidly decreased after curative surgery for biliopancreatic cancer and recovered to normal levels about 5 weeks later. Clinicians should be aware and cautious that patients with low NKA at admission may fail to recover NKA postoperatively.
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Affiliation(s)
- Eun Y Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae H Hong
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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9
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Yang MJ, Hwang JC, Lee D, Kim YB, Yoo BM, Kim JH. Factors affecting the diagnostic yield of endoscopic transpapillary forceps biopsy in patients with malignant biliary strictures. J Gastroenterol Hepatol 2021; 36:2324-2328. [PMID: 33729610 DOI: 10.1111/jgh.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/14/2021] [Accepted: 03/14/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Transpapillary biliary forceps biopsy (TBFB) is a common method to obtain histological evidence for the differential diagnosis of biliary stricture. This study aimed to evaluate the factors associated with a positive cancer diagnosis from TBFB and the number of tissue samples required to increase the diagnostic yield in patients with malignant biliary strictures. METHODS A total of 376 patients who underwent TBFB for investigation of biliary stricture were included. Factors affecting the diagnostic yield of TBFB were determined using univariate analysis and multivariate logistic regression analyses. RESULTS Bile duct cancer (odds ratio [OR] = 3.50, P = 0.002), intraductal growing type (OR = 9.01, P = 0.001), and number of tissue samples (n < 5 vs 5 ≤ n < 10, OR = 4.13, P = 0.01; n < 5 vs n ≥ 10, OR = 12.25, P < 0.001; 5 ≤ n < 10 vs n ≥ 10, OR = 2.97, P = 0.046) were significant factors associated with positive results for malignancy. In patients with periductal infiltrating-type bile duct cancer, the number of tissue samples was a significant factor for diagnostic sensitivity (54.3% in the n < 5 group, 83.3% in the 5 ≤ n < 10 group and 98.2% in the n ≥ 10 group) (P < 0.001). CONCLUSIONS Bile duct cancer, intraductal growing type, and five or more tissue samples were significant predictors of positive TBFB results in patients with malignant biliary stricture. Increasing the number of tissue samples by five or more led to higher sensitivity in bile duct cancer patients with the periductal infiltrating type.
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Affiliation(s)
- Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Jae Chul Hwang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Dakeun Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, South Korea
| | - Young Bae Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, South Korea
| | - Byung Moo Yoo
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Jin Hong Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
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10
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Prakash GS, Amin A, Paterno F, Brown LG, Guarrera JV, Lunsford KE. Is liver transplantation a viable option for the treatment of intrahepatic cholangiocarcinoma? J Surg Oncol 2021; 124:906-907. [PMID: 34120341 DOI: 10.1002/jso.26573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Gagan S Prakash
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Arpit Amin
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Flavio Paterno
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Lloyd G Brown
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James V Guarrera
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Keri E Lunsford
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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11
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Sawada K, Kurita A, Yazumi S. An unusual tumor of the bile duct. J Hepatobiliary Pancreat Sci 2021; 28:e26-e27. [PMID: 33896104 DOI: 10.1002/jhbp.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 11/09/2022]
Abstract
Highlight Sawada and colleagues report a case of mucinous cholangiocarcinoma not originating from intraductal papillary neoplasm of the bile duct. While recognizing the imaging features of the bile ducts is difficult due to their narrow area, the detailed characteristic features may enable preoperative diagnosis of this rare type of cholangiocarcinoma.
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Affiliation(s)
- Kenji Sawada
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Akira Kurita
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Shujiro Yazumi
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
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12
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Kang MJ, Lim J, Han SS, Park HM, Kim SW, Won YJ, Park SJ. Impact of changes in the topographic classification of Klatskin tumor on incidence of intra- and extrahepatic bile duct cancer: A population-based national cancer registry study. J Hepatobiliary Pancreat Sci 2021; 28:740-750. [PMID: 33615747 DOI: 10.1002/jhbp.916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/17/2021] [Accepted: 01/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Misclassification of Klatskin tumor as intrahepatic rather than extrahepatic bile duct cancer (eBDC) may overestimate the incidence of intrahepatic BDC (iBDC). This study aimed to investigate the impact of misclassified Klatskin tumor on iBDC and eBDC incidences in Korea, where BDC is highly endemic. METHODS The data of incidence, topography and morphology code of BDC from 1999 to 2017 were obtained from the Korea Central Cancer Registry, which covers the entire 51.6 million Korean population. For misclassification analysis, all Klatskin tumors were reclassified as eBDC. RESULTS Klatskin tumors accounted for 13.5% of all 81 414 BDC cases. In the registry, an average of 59.7% of Klatskin tumors were classified as iBDC, gradually decreasing from 95.5% to 16.9%. Misclassification led to a 17.3% overestimation of iBDC cases and a 15.0% underestimation of eBDC cases on average. After reclassification, age standardized rate (ASR) of incidence per 100 000 population decreased in iBDC from 3.4 to 2.9 and increased in eBDC from 2.8 to 3.2. Average annual percentage change of iBDC and eBDC incidences were 2.0% and 1.2%, respectively, but ASR of iBDC significantly decreased since 2012 (P < 0.0001). CONCLUSIONS Misclassification of Klatskin tumors has remarkable impact on the incidence of iBDC and eBDC in a highly endemic country.
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Affiliation(s)
- Mee Joo Kang
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jiwon Lim
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea
| | - Sung-Sik Han
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Hyeong Min Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Sun-Whe Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea.,Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Sang-Jae Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
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13
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Xia MX, Pan YL, Cai XB, Wu J, Gao DJ, Ye X, Wang TT, Hu B. Comparison of endoscopic bilateral metal stent drainage with plastic stents in the palliation of unresectable hilar biliary malignant strictures: Large multicenter study. Dig Endosc 2021; 33:179-189. [PMID: 32249460 DOI: 10.1111/den.13680] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endoscopic stenting to manage malignant hilar biliary obstruction has no consensus regarding the optimal stenting strategy. In this multicenter study, we compared transpapillary parallel-style bilateral metal stenting with bilateral plastic stenting, and evaluated short- and long-term outcomes. METHODS We recruited 262 consecutive patients (Bismuth classification types II-IV) who underwent either bilateral metal or plastic stenting as primary therapy at four tertiary centers. To overcome selection bias, we performed 1:1 propensity score matching. Our primary outcome was overall survival. RESULTS After propensity score matching, each group comprised 96 patients, with no significant differences in any baseline characteristics. The median survival was significantly longer in the metal stenting group than in the plastic stenting group (7.2 months [95% CI 6.0-8.5] vs. 4.1 months [95% CI 2.9-5.3]; P = 0.015). The clinical success rates were significantly higher in the metal stenting group than in the plastic stenting group (99.0% vs. 71.9%, respectively; P < 0.001), and lower post-procedure cholangitis incidence (7.3% vs. 26.0%; P < 0.001), longer median symptom-free stent patency (9.2 months [95% CI 7.6-10.6] vs. 4.8 months [95% CI 4.2-5.3]; P < 0.001), and fewer total interventions (1.3 ± 0.6 vs. 2.0 ± 1.4; P < 0.001). In multivariate Cox analysis of the overall survival, metal stenting (HR 0.589, P = 0.002), hilar cholangiocarcinoma (HR 0.419, P = 0.009), and adjuvant treatment (HR 0.596, P = 0.006) were independent predictors of death. CONCLUSIONS Endoscopic therapy using bilateral metal stenting is superior to bilateral plastic stenting, with prolonged overall survival, higher clinical success, and longer stent patency in patients with advanced hilar biliary malignancies.
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Affiliation(s)
- Ming-Xing Xia
- Departments of, Department of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Yang-Lin Pan
- Department of, Gastroenterology, Xijing Hospital Affiliated to Fourth Military Medical University, Xi'an, China
| | - Xiao-Bo Cai
- Department of, Gastroenterology, Shanghai First People's Hospital, Shanghai, China
| | - Jun Wu
- Department of, Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China
| | - Dao-Jian Gao
- Departments of, Department of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Xin Ye
- Departments of, Department of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Tian-Tian Wang
- Departments of, Department of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Bing Hu
- Departments of, Department of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.,Department of, Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China
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14
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Xia MX, Wang SP, Wu J, Gao DJ, Ye X, Wang TT, Zhao Y, Hu B. The risk of acute cholangitis after endoscopic stenting for malignant hilar strictures: A large comprehensive study. J Gastroenterol Hepatol 2020; 35:1150-1157. [PMID: 31802535 DOI: 10.1111/jgh.14954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM Endoscopic stenting for unresectable malignant hilar biliary strictures (MHBS) remains challenging. Post-endoscopic retrograde cholangiopancreatography cholangitis (PEC) can be the most common and fatal adverse event. In the present study, we aimed to systematically evaluate the incidence, severity, risk factors, and consequences of PEC after endoscopic procedures for advanced MHBS. METHODS Of 924 patients, we identified 502 patients with MHBS (Bismuth types II to IV) who underwent endoscopic stenting as the primary therapy at two centers over 16 years. PEC and its severity were verified according to the current Tokyo guidelines. RESULTS A total of 108 patients (21.5%) experienced acute PEC. Mild, moderate, and severe cholangitis were encountered in 51 (10.1%), 42 (8.4%), and 15 (3.0%) patients, respectively. Multivariate analyses showed that metal stenting (verse plastic stenting) (OR 0.328, 95% CI 0.200-0.535, P < 0.001) and Bismuth classification (IV vs III/II) (OR 2.499, 95% CI 1.150-5.430) were independent predictors for PEC and the moderate/severe type. Patients with PEC had significantly lower clinical success rates (86.3% vs 41.7%, P < 0.001), a higher rate of early death (6.5% vs 0.5%, P < 0.001), a shorter median stent patency (4.9 vs 6.4 months, P < 0.001), and shorter overall survival (2.6 vs 5.2 months, P < 0.001) compared with the noncholangitis group. CONCLUSIONS After endoscopic stenting for advanced MHBS, cholangitis may occur in as many as 21.5% of patients, which may be associated with a poor prognosis. The risk is high in patients with Bismuth type IV and may be reduced by using metal stents.
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Affiliation(s)
- Ming-Xing Xia
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Shu-Ping Wang
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wu
- Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China
| | - Dao-Jian Gao
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Xin Ye
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Tian-Tian Wang
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Yi Zhao
- Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China
| | - Bing Hu
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China
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15
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Fukuba N, Ishitobi H, Takahashi Y. Duplication of extrahepatic bile duct with lower common bile duct cancer. J Hepatobiliary Pancreat Sci 2020; 27:665-666. [PMID: 32506825 DOI: 10.1002/jhbp.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/16/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022]
Abstract
Highlight Fukuba and colleagues report a case of lower common bile duct cancer with the extremely rare anomaly of left and right bile ducts parallel with the duodenal papilla, and joined distally to form a single short common bile duct. Fully covered metallic stents were placed in a side-by-side manner.
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Affiliation(s)
- Nobuhiko Fukuba
- Department of Internal Medicine, Izumo-city General Medical Center, Izumo, Japan
| | - Hitomi Ishitobi
- Department of Internal Medicine, Izumo-city General Medical Center, Izumo, Japan
| | - Yoshiko Takahashi
- Department of Internal Medicine, Izumo-city General Medical Center, Izumo, Japan
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16
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Sato M, Okachi S, Fukihara J, Shimoyama Y, Wakahara K, Sakakibara T, Hase T, Onishi Y, Ogura Y, Maeda O, Hasegawa Y. Lung Metastases from Bile Duct Adenocarcinoma Mimicking Chronic Airway Infection and Causing Diagnostic Difficulty. Intern Med 2018; 57:1429-1432. [PMID: 29279503 PMCID: PMC5995711 DOI: 10.2169/internalmedicine.9718-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of lung metastases with unusual radiological appearances that mimicked those of chronic airway infection, causing diagnostic difficulty. A 60-year-old woman who underwent liver transplantation from a living donor was incidentally diagnosed with bile duct adenocarcinoma after a histopathological analysis of her explanted liver. Six months later, chest computed tomography (CT) revealed bilateral bronchogenic dissemination that had gradually worsened, suggesting chronic airway infection. A biopsy with bronchoscopy from a mass lesion beyond a segmental bronchus revealed adenocarcinoma identical to that of her bile duct adenocarcinoma, leading to the diagnosis of multiple lung metastases from bile duct adenocarcinoma.
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Affiliation(s)
- Mitsuo Sato
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Shotaro Okachi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Jun Fukihara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Yoshie Shimoyama
- Department of Pathology, Nagoya University Graduate School of Medicine, Japan
| | - Keiko Wakahara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Toshihiro Sakakibara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Tetsunari Hase
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Yasuharu Onishi
- Department of Transplantation Surgery, Nagoya University Hospital, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, Japan
| | - Osamu Maeda
- Department of Clinical Chemotherapy and Pharmacology, Nagoya University Graduate School of Medicine, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
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17
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Alexander LF, Harri P, Little B, Moreno CC, Mittal PK. Magnetic Resonance Imaging of Primary Hepatic Malignancies in Patients With and Without Chronic Liver Disease: A Pictorial Review. Cureus 2017; 9:e1539. [PMID: 28989828 PMCID: PMC5628780 DOI: 10.7759/cureus.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Primary hepatic malignancies are less common than metastatic diseases, but a recognition of these lesions is important for diagnosis and treatment planning. Magnetic resonance imaging (MRI) provides the most imaging information to diagnose lesions noninvasively and to narrow differential diagnoses. This paper reviews the imaging findings of chronic liver disease and primary hepatic malignancies, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCA), epithelioid hemangioendothelioma, hepatic angiosarcoma, and primary hepatic lymphoma. Clinical and MRI features are reviewed to improve the readers’ recognition of these tumors, allowing for a narrower differential diagnosis when liver masses are encountered on abdominal imaging.
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Affiliation(s)
- Lauren F Alexander
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Peter Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Brent Little
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
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18
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Wang W, Chen W, Li K, Wang J. Successful treatment of biliary intraepithelial neoplasia in the common bile duct via local excision: A case report. Oncol Lett 2016; 11:3142-3144. [PMID: 27123079 DOI: 10.3892/ol.2016.4336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 02/12/2016] [Indexed: 12/28/2022] Open
Abstract
Biliary intraepithelial neoplasia (BilIN), a precursor lesion of bile duct adenocarcinomas, rarely occurs in the extrahepatic bile duct, and therefore uniform treatment guidelines are lacking. The present study reports a case of BilIN in the common bile duct (CBD) in a 77-year-old man, who presented with upper abdominal malaise without jaundice. Imaging modalities revealed a CBD luminal tumor and dilated intrahepatic and extrahepatic bile ducts. To the best of our knowledge, local excision of the lesion was performed for the first time for this type of tumor in the present study. Pathological examination gave a definite diagnosis of high-grade BilIN in the CBD. No evidence of recurrence was observed during a 3-year follow-up period. This case report suggests that local excision is able to successfully treat BilIN in the CBD.
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Affiliation(s)
- Wei Wang
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Wei Chen
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Kewei Li
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Jian Wang
- Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
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Naitoh I, Nakazawa T, Kato A, Hayashi K, Miyabe K, Shimizu S, Kondo H, Nishi Y, Yoshida M, Umemura S, Hori Y, Kuno T, Takahashi S, Ohara H, Joh T. Predictive factors for positive diagnosis of malignant biliary strictures by transpapillary brush cytology and forceps biopsy. J Dig Dis 2016; 17:44-51. [PMID: 26717051 DOI: 10.1111/1751-2980.12311] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/17/2015] [Accepted: 12/24/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The diagnostic yields of endoscopic transpapillary brush cytology and forceps biopsies for malignant biliary strictures (MBS) remain unclear and predictive factors for diagnosis have not been established. We aimed to clarify the diagnostic yields of both methods and the predictive factors METHODS We reviewed 241 patients with biliary strictures who underwent transpapillary brush cytology (n = 202) or forceps biopsy (n= 208) between 2004 and 2014 at a single academic center. RESULTS The sensitivity of forceps biopsy for MBS was significantly higher than that of brush cytology [60.6% (97/160) vs 36.1% (57/158), P < 0.01). The sensitivity of forceps biopsy was significantly higher in diagnosing bile duct cancer than pancreatic cancer [78.8% (52/66) vs 42.4% (28/66), P < 0.01). Multivariate analysis revealed that serum total bilirubin (TB) level (T-Bil) ≥ 4 mg/dL [odds ratio (OR) 2.506, 95% confidence interval (CI): 1.139-5.495, P = 0.022) was an independent predictor for positive diagnosis by brush cytology, while bile duct cancer (OR 4.926, 95% CI 2.183-11.111, P < 0.001), stricture length ≥ 30 mm (OR 2.941, 95% CI 1.119-7.752, P = 0.029) and TB ≥ 4 mg/dL (OR 2.252, 95% CI 1.052-4.831, P = 0.037) were significant indicators of a positive diagnosis by forceps biopsy. CONCLUSIONS Endoscopic transpapillary forceps biopsy shows higher sensitivity than that of brush cytology for MBS. Bile duct cancer, stricture length ≥ 30 mm and TB ≥ 4 mg/dL are good indicators of forceps biopsy.
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Affiliation(s)
- Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Takahiro Nakazawa
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Akihisa Kato
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Katsuyuki Miyabe
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Shuya Shimizu
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Hiromu Kondo
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Yuji Nishi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Shuichiro Umemura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Yasuki Hori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
| | - Toshiya Kuno
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences
| | - Satoru Takahashi
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences
| | - Hirotaka Ohara
- Department of Community-based Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences
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Lu BC, Ren PT. Treatment of hilar cholangiocarcinoma of Bismuth-Corlette type III with hepaticojejunostomy. Contemp Oncol (Pozn) 2013; 17:298-301. [PMID: 24596518 DOI: 10.5114/wo.2013.35274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 09/28/2012] [Accepted: 10/30/2012] [Indexed: 02/02/2023] Open
Abstract
Aim of the study The present study aims to explore the value of application of hepaticojejunostomy in surgical treatment of Bismuth-Corlette type III hepatic hilar cholangiocarcinoma. Material and methods The clinical data of hepaticojejunostomy in 6 patients with Bismuth-Corlette type III hepatic hilar cholangiocarcinoma from January 2008 to October 2011 were retrospectively analyzed. There were 5 males and 1 female, aged 45–69 years, on average 58 years old. There were 3 cases of Bismuth-Corlette type IIIa and 3 cases of Bismuth-Corlette type IIIb. Results The 6 patients all successfully underwent hepaticojejunostomy, with operation time of 160–310 min, on average 210 ±28 min. One patient suffered a small amount of bile leakage (3–20 ml) and his drainage tube was taken out after being cured with conservative treatment for 18 days. Three patients showed postoperative mild increases of aspartate aminotransaminase (AST), alanine transaminase (ALT) and AKP, which were improved after drug treatments. There was no biliary stricture in the 6 patients after follow-up for 3–18 months. Conclusions Hepaticojejunostomy was simple and flexible, with a good effect on biliary reconstruction of Bismuth-Corlette type III hepatic hilar cholangiocarcinoma. It solved the difficulties in multiple choledochojejunostomy, and with less complications; therefore, it is worth being popularized.
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Abstract
Primary sclerosing cholangitis (PSC) is a chronic, cholestatic, idiopathic liver disease characterized by fibro-obliterative inflammation of the hepatic bile ducts. In a clinically significant proportion of patients, PSC progresses to cirrhosis, end-stage liver disease, and in some cases, cholangiocarcinoma (CCA). The development of CCA in PSC is unpredictable, its surveillance and diagnosis complex, and its treatment options limited unless detected early. Herein we provide a focused review of the current literature regarding CCA surveillance in patients with PSC and discuss the diagnostic and management challenges that exist. Where evidence is limited, we present our perspective and approach as well as directions for future research.
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Affiliation(s)
- James H. Tabibian
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Keith D. Lindor
- Executive Vice Provost, Health Solutions, Arizona State University, P.O. Box 877805, Tempe, AZ 85287-7805, USA
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Abstract
We report a case of a 46-year-old man with a stricture of the bile duct which was caused by neuroma. The patient had a history of six months jaundice without a previous history of abdominal surgical operation. MR imaging and MRCP clearly picked up the dilatation of intrahepatic biliary ducts and the level of stenosis, but it was very difficult to differentiate benign neuroma from malignant stenosis of the common bile duct. Results of preoperative CT, MRI and ERCP evaluation and postoperative histological examination were presented.
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Affiliation(s)
- John Tsitouridis
- Department of Radiology and Gastroenterology, General Army Hospital of Thessaloniki, Thessaloniki, Greece
| | - Georgios Kouklakis
- Department of Radiology and Gastroenterology, General Army Hospital of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Xiarhos
- Department of Radiology and Gastroenterology, General Army Hospital of Thessaloniki, Thessaloniki, Greece
| | - Fotini Patakiuta
- Department of Radiology and Gastroenterology, General Army Hospital of Thessaloniki, Thessaloniki, Greece
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