Assessment of Nodal Status for Perihilar Cholangiocarcinoma

Aoba, Taro; Ebata, Tomoki; Yokoyama, Yukihiro; Igami, Tsuyoshi; Sugawara, Gen; Takahashi, Yu; Nimura, Yuji; Nagino, Masato

doi:10.1097/sla.0b013e3182822277

Cited by 136 publications

(113 citation statements)

References 42 publications

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“…Thus, the remaining 180 patients, who accounted for 37.2 % of the patients who underwent resection, were included in this retrospective study. Twenty-nine patients with distant lymph node (celiac artery, superior mesenteric artery, and/ or periaortic lymph node) metastasis were included in this study because the results of our previous study indicated that the survival rates of patients with regional node metastasis alone and those with distant node metastasis did not differ to a statistically significant extent [19].…”

Section: Introductionmentioning

confidence: 99%

“…Many surgeons have adopted an aggressive approach to PHC [1][2][3][4][5][6][7][8][9][10][11][12][13][14]; however, recurrence is common, even after curative resection and the rate of survival after resection remains unsatisfactory, with a 5-year survival rate of 26-56 % [3,13,[15][16][17][18]. Lymph node metastasis is reported to be one of the most important prognostic factors, and overall survival following resection in patients with lymph node involvement is significantly worse than that in patients without lymph node involvement [2,3,6,7,13,14,17,19,20]. Surgery alone is, therefore, not sufficient for improving the survival of lymph node-positive PHC patients.…”

Section: Introductionmentioning

confidence: 99%

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Adjuvant gemcitabine monotherapy for resectable perihilar cholangiocarcinoma with lymph node involvement: a propensity score matching analysis

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adjuvant gemcitabine monotherapy for resectable perihilar cholangiocarcinoma with lymph node involvement: a propensity score matching analysis

et al. 2016

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“…Presence of LN metastasis and the number of malignant LN are associated with survival. 95,96 A recent meta-analysis reported higher rate of LN metastases in patients who underwent PVR compared to those who did not, and significantly poorer overall survival. 97 …”

Section: 81mentioning

confidence: 99%

Comprehensive management of cholangiocarcinoma: Part II. Treatment

Papafragkakis

Lee

2017

Int J Gastrointest Interv

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Cholangioarcinoma is a rare but dreadful malignancy which poses much difficulties in the management. If detected early with only localized disease, curative resection is possible. However, most patients present in the late stages of the disease, which are managed with endoscopic biliary drainage and/or chemoradiation. Liver transplantation offers a possibility for cure in the distal and the perihilar tumors for selected candidates. Local treatments, such as hepatic artery-based therapies, brachytherapy, and photodynamic therapy, may offer some benefit in cases of the advanced disease. In this review, we will assess the role of preoperative biliary drainage, how best to drain biliary obstruction, and the intricate details of various treatments that are currently available. Management of Cholangiocarcinoma Preoperative biliary drainagePreoperative biliary drainage (PBD) is achieved with endoscopic or percutaneous approach. The topic is controversial and the review of the literature revealed conflicting results. PBD of the future remnant hepatic lobe is supposed to decrease hepatic dysfunction and liver failure postoperatively.1 The meta-analysis found no difference in mortality between patients with and without PBD and the authors advised that such procedure should not be performed routinely.2 Another meta-analysis of almost 5,000 patients with distal obstruction (425 with distal cholangiocarcinoma [DCC]) did not find any evidence that PBD (without distinguishing between endoscopic or percutaneous approach) increases morbidity or mortality. However it was associated with significant bacterial infection of the bile and possibly adverse outcomes after surgery.3 Other studies showed that PBD reduced jaundice, which positively affected outcomes, but not survival, and that it might be associated with more intraoperative blood loss, but less reoperation rates compared to non-drained cases. 4,5 The prospective randomized study of almost 200 patients with cancer of the head of the pancreas demonstrated that PBD was associated with more non-surgical adverse events compared to those managed only with surgery (46% vs 2%, respectively). Surgical adverse events were also more in the PBD group (47% vs 37%). The high incidence of cholangitis in those treated with PBD may be associated with the long lag time between PBD and surgery (5 weeks) and the high occlusion rate of plastic stents (PSs) (15%), prompting other authors to suggest that use of short, self-expandable metal stents (SEMS) may result in better outcomes for distal bile duct strictures. In accordance with other studies, there was no effect of PBD on mortality.6,7 In perihilar cholangiocarcinoma (PCC), the systematic review of 700 patients with and without PBD suggested that there is higher incidence of postoperative infections (18%-52% vs 0%-27%) and overall adverse events (36%-100% vs 29%-72%) in the PBD compared to the non-PBD group. There was no difference in mortality in the two groups. 8 Other studies favor the use of PBD in the preoperative management of PCC. ...

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“…Most patients will undergo endoscopic retrograde cholangiopancreatography (ERCP), which can accomplish three goals: (I) biliary decompression and stent placement in cases of severe obstruction (total bilirubin >10-15 mg/dL); (II) assessment of the aggressiveness and location of the tumor; and (III) assessment of ductal brushings for histologic diagnosis. CC lymph node involvement has been estimated to be as high as 46% in one surgical series (5). For CC, first echelon lymphatic drainage includes hepatic, retroportal, and pancreaticoduodenal stations, while second echelon drainage comprises peripancreatic, aortocaval, and celiac lymph nodes.…”

Section: Patient Evaluationmentioning

confidence: 99%