Adenocarcinoma of the Distal Bile Duct

Bortolasi, Luca; Burgart, Lawrence J.; Tsiotos, Gregory G.; León, Enrique Luque-de; Sarr, Michael G.

doi:10.1159/000018798

Cited by 32 publications

(4 citation statements)

References 18 publications

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“…Actually, most patients undergo biliary drainage prior to referral for resection, despite the lack of data showing a benefit. Clearly, the presence of cholangitis mandates biliary decompression, but there is no proof that routine biliary drainage in all patients facilitates resection or reduces postsurgical morbidity [55,56] . On the contrary, the available data would suggest that biliary stents are associated with greater postoperative infection complications [57,58] .…”

Section: Preoperative Biliary Drainagementioning

confidence: 99%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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vein embolization and staging laparoscopy should be considered in selected patients. Additional evidence is needed to fully define the role of orthotopic liver transplant. Portal and lymph node involvement worsen the prognosis and long-term survival, and surgery is the only option that can lengthen it. Improvements in adjuvant therapy are essential for improving long-term outcome. Furthermore, the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option, because operated patients have a longer survival rate than those who not undergo surgery. INTRODUCTIONCarcinomas arising from the confluence of the hepatic ducts were first described by Altemeier et al [1] . Klatskin [2] Alejandro Serrablo, Luis Tejedor Outcome of surgical resection in Klatskin tumors TOPIC HIGHLIGHT AbstractCholangiocarcinomas are the second most frequent primary hepatic malignancy, and make up from 5% to 30% of malignant hepatic tumours. Hilar cholangiocarcinoma (HCC) is the most common type, and accounts for approximately 60% to 67% of all cholangiocarcinoma cases. There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease. Neither the extension of resection, according to the sort of HCC, is a closed topic. Some authors defend limited resection (mesohepatectomy with S1, S1 plus S4b-S5, local excision for papillary tumours, etc .) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure. As there is not an ideal adjuvant therapy, R1 resection can be justified to prolong the survival rate. Morbidity and mortality rates changed along the last decade, but variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Conclusion: Surgical resection continues to be the main treatment of HCC. Negative resection margins achieved with major hepatic resections are associated with improved outcome. Preresectional management with biliary drainage, portal José M Ramia, MD, PhD, Series Editor

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Section: Preoperative Biliary Drainagementioning

confidence: 99%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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“…2 Surgery remains the only curative option for patients with cholangiocarcinoma, with a 5-year survival rate ranging from 9% to 41% for patients undergoing resection of extrahepatic cholangiocarcinoma. 3–6 Recent data from our own group have suggested that survival after curative resection of cholangiocarcinoma may have been increasing over the last 3 decades. 7 …”

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confidence: 99%

Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma

Hong

Pawlik

Cho

et al. 2009

Surgery

117

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Background The American Joint Committee on Cancer (AJCC) T classification system for cholangiocarcinoma does not take into account the unique pathologic features of the bile duct. As such, the current AJCC T classification for distal cholangiocarcinoma may be inaccurate. Methods A total of 147 patients with distal cholangiocarcinoma were identified from a single institution database. The prognostic importance of depth of tumor invasion relative to the AJCC T classification system was assessed. Results The AJCC T classification was T1 (n = 11, 7.5%), T2 (n = 6, 4.1%), T3 (n = 73, 49.7%), or T4 (n = 57, 38.8%). When cases were analyzed according to depth of tumor invasion, most lesions were ≥5 mm (<5 mm, 9.5%; range, 5–12, 51.0%; >12 mm, 39.5%). The AJCC T classification was not associated with survival outcome (median survival, T1, 40.1 months; T2, 14.8 months; T3, 16.5 months; T4, 20.2 months; P = .17). In contrast, depth of tumor invasion was associated with a worse outcome as tumor depth increased (median survival, <5 mm, not reached; range, 5–12, 28.9 months; >12 mm, 12.9 months; P = .001). On multivariate analyses, tumor depth remained the factor most associated with outcome (<5 mm; hazard ratio [HR] = referent vs 5–12 mm; HR = 3.8 vs >12 mm; HR = 6.7 mm; P = .001). Conclusion The AJCC T classification for distal cholangiocarcinoma does not accurately predict prognosis. Depth of the bile duct carcinoma invasion is a better alternative method to determine prognosis and should be incorporated into the pathologic assessment of resected distal cholangiocarcinoma.

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“…The 5-year survival rates after pancreatoduodenectomy for distal bile duct cancer varies between 20% and 40% [5][6][7][8], which is not a lot better than that for pancreatic ductal cancer, although the type of the recurrence is much different. The cause of death for resected distal bile duct cancer was mainly due to liver metastases and peritoneal dissemination, and local recurrence appeared only in patients with positive resection margins.…”

Section: Discussionmentioning

confidence: 96%

“…Local recurrence is one of the most frequent forms of pancreatic cancer recurrence, even after margin-negative resection [3,4]. In contrast, it has been reported that local recurrence is rare in patients who undergo pancreatoduodenectomy for distal duct cancer [5][6][7][8], ampullary cancer [9,10], or duodenal cancer [11][12][13][14]. Based on these reports, we can easily speculate that the type of reconstruction (the root of the alimentary tract) may affect the postoperative course of the patients.…”

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confidence: 99%

Impact of Reconstruction Methods on Outcome of Pancreatoduodenectomy in Pancreatic Cancer Patients

et al. 2005

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Local recurrence is one of the most frequent forms of pancreatic cancer recurrence, although local recurrence is rare for other periampullary cancers. Because the type of recurrence and outcome differ depending on the type of cancer, these factors should be considered when the type of reconstruction is chosen. Fifty-four pancreatoduodenectomies were performed in patients with ductal adenocarcinoma of the pancreas from 1994 to 2001. Billroth I reconstruction was performed in 27 consecutive patients before 1999, and thereafter Billroth II reconstruction was performed in another consecutive 27 patients. Postoperative nasogastric intubation and the duration before oral ingestion were longer for Billroth I patients than Billroth II patients. Seven complications occurred in Billroth I patients, whereas there were two complications in Billroth II patients. Disease-free survival and overall survival were not different between the two groups; however, bypass operations were required in nine patients of the Billroth I group and in one patient of the Billroth II group. Percutaneous transhepatic cholangio-drainage (PTCD) procedures were required in six patients of the Billroth I goup and in two patients of the Billroth II group. The Billroth II reconstruction may have some advantages over the Billroth I reconstruction in terms of postoperative oral ingestion and avoiding bypass surgery and PTCD at the time of recurrence.

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Adenocarcinoma of the Distal Bile Duct

Cited by 32 publications

References 18 publications

Outcome of surgical resection in Klatskin tumors

Outcome of surgical resection in Klatskin tumors

Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma

Impact of Reconstruction Methods on Outcome of Pancreatoduodenectomy in Pancreatic Cancer Patients

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