Carcinoma of the middle bile duct: Is bile duct segmentalresection appropriate?

Lee, Hyung Geun; Lee, Sang Hoon; Yoo, Dong Do; Paik, Kwang Yeol; Heo, Jin Seok; Choi, Seong Ho; Choi, Dong Wook

doi:10.3748/wjg.15.5966

Cited by 28 publications

(27 citation statements)

References 28 publications

(42 reference statements)

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“…Moreover, MMP1 appears to be a key determinant that selectively mediates lung metastasis in a murine breast cancer model (Minn et al, 2005, 2007; Nguyen and Massague, 2007). MMP13 (collagenase-3) originally identified in human breast cancer tissue (Freije et al, 1994) is viewed as a potential tumor marker for breast cancer diagnosis (Chang et al, 2009) and its expression is correlated with metastasis formation (Ellsworth et al, 2009; Lee et al, 2009). In experimental models, MMP13 appears as a key stromal mediator of cancer progression that regulates the release of angiogenic factors (Lederle et al, 2009) and metastatic dissemination (Zigrino et al, 2009).…”

Section: Collagen Remodelingmentioning

confidence: 99%

New and Paradoxical Roles of Matrix Metalloproteinases in the Tumor Microenvironment

Noël¹,

Gutiérrez‐Fernández²,

Sounni³

et al. 2012

Front. Pharmacol.

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Processes such as cell proliferation, angiogenesis, apoptosis, or invasion are strongly influenced by the surrounding microenvironment of the tumor. Therefore, the ability to change these surroundings represents an important property through which tumor cells are able to acquire specific functions necessary for tumor growth and dissemination. Matrix metalloproteinases (MMPs) constitute key players in this process, allowing tumor cells to modify the extracellular matrix (ECM) and release cytokines, growth factors, and other cell-surface molecules, ultimately facilitating protease-dependent tumor progression. Remodeling of the ECM by collagenolytic enzymes such as MMP1, MMP8, MMP13, or the membrane-bound MT1-MMP as well as by other membrane-anchored proteases is required for invasion and recruitment of novel blood vessels. However, the multiple roles of the MMPs do not all fit into a simple pattern. Despite the pro-tumorigenic function of certain metalloproteinases, recent studies have shown that other members of these families, such as MMP8 or MMP11, have a protective role against tumor growth and metastasis in animal models. These studies have been further expanded by large-scale genomic analysis, revealing that the genes encoding metalloproteinases, such as MMP8, MMP27, ADAM7, and ADAM29, are recurrently mutated in specific tumors, while several ADAMTSs are epigenetically silenced in different cancers. The importance of these proteases in modifying the tumor microenvironment highlights the need for a deeper understanding of how stroma cells and the ECM can modulate tumor progression.

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Section: Collagen Remodelingmentioning

confidence: 99%

New and Paradoxical Roles of Matrix Metalloproteinases in the Tumor Microenvironment

Noël¹,

Gutiérrez‐Fernández²,

Sounni³

et al. 2012

Front. Pharmacol.

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“…This was a hilar cholangiocarcinoma not invading other structures or adjacent organs. Therefore, limited surgical resection was justified as has been reported by Hyung et al [6]. The functional and oncological outcomes of complete laparoscopic surgery were found to be adequate.…”

Section: Discussionmentioning

confidence: 78%

Laparoscopic Management of Hilar Cholangiocarcinoma: a Case Report

et al. 2015

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The only option for cure of Klatskin's tumour is surgical excision. The radicality of the procedure is determined by the extent of the tumour and functional parameters of the patient. Complete laparoscopic resection of hilar cholangiocarcinoma with biliary reconstruction is a challenging procedure. The main aim is to achieve pathological negative margins, complete lymph node retrieval and enterobiliary bypass. We present a case report of a patient with hilar cholangiocarcinoma managed laparoscopically. The nodal yield was nine. On 6-month follow-up, the patient was symptom free. The main aim is to study the feasibility of performing this complex procedure completely laparoscopically.

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“…First, we classified extrahepatic BD cancer as DISTAL (confined to intrapancreatic BD) and MID/DIFFUSE (involving extrapancreatic BD). Previous studies have classified middle BD cancer as tumors confined to the mid BD (MID group in our study) which could be treated with BD resection, and distal BD cancer as involvement with the intrapancreatic portion of the BD or diffuse BD cancer (DISTAL and DIFFUSE group in this study), in which PD was necessary [ 9 , 15 ]. In others, tumors were classified by the predominant location of the tumor without considering diffuse bile duct cancer, DIFFUSE in our study [ 5 , 13 ].…”

Section: Discussionmentioning

confidence: 98%

“…In the tumor is confined to the middle BD, there have been debates about whether segmental BD resection is an adequate operative procedure or not [ 6 ]. A few studies have shown that similar incidence of positive surgical margin and similar long-term results between segmental BD resection and PD in the cancer confined to middle BD [ 7 , 15 , 26 , 28 ]. Our results showed that the clinical characteristics and long-term results between MID and DIFFUSE were not different, and the long-term results according to the operative procedure, either BD resection or PD in these groups, were also similar (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the appropriate operative procedure for tumors confined to the middle BD has not been fully defined. Although usually, PD is needed for curative resection in mid BD cancer, there has been debate about whether segmental resection of the bile duct can be an alternative treatment or not when negative margins can be obtained [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Confinement to the intrapancreatic bile duct is independently associated with a better prognosis in extrahepatic cholangiocarcinoma

Ahn

Kang

et al. 2016

BMC Gastroenterol

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BackgroundActual differences of long term outcome of extrahepatic cholangiocarcinoma according to the location of the tumor have not yet been studied. The aim of this study was to evaluate the prognosis and optimal surgical procedure for middle (BD) cancer.MethodsAmong 109 patients with carcinoma of the extrahepatic BD underwent surgical resection, curative resection of extrahepatic BD cancer was performed in 90 patients. They were classified into three groups according to the location of tumors: DISTAL (n = 32), tumor was confined to the intrapancreatic bile duct; MID (n = 20), tumor was located between below the confluence of the hepatic duct bifurcation and suprapancreatic portion of the BD; and DIFFUSE (n = 38), tumor was located diffusely.ResultsTumor involving the middle BD (MID or DIFFUSE) had a higher rate of perineural invasion as compared to the DISTAL group. The overall and disease-free survival rate for the MID or DIFFUSE group was significantly worse than that of DISTAL. In the MID/DIFFUSE group, there was no significant difference of survival according to the type of the operation (pancreaticoduodenectomy or segmental BD resection). The multivariate analysis showed that tumor involving middle BD (MID or DIFFUSE group) and node metastasis were independently poor prognostic factors for the disease free and overall survival.ConclusionExtrahepatic cholangiocarcinoma involving the extrapancreatic BD has a worse prognosis than those confined to the intrapancreatic BD. In patients with tumors confined to the middle BD, BD resection can be considered as an alternative surgical procedure to pancreaticoduodenectomy, if an R0 resection can be accomplished.

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Carcinoma of the middle bile duct: Is bile duct segmentalresection appropriate?

Cited by 28 publications

References 28 publications

New and Paradoxical Roles of Matrix Metalloproteinases in the Tumor Microenvironment

New and Paradoxical Roles of Matrix Metalloproteinases in the Tumor Microenvironment

Laparoscopic Management of Hilar Cholangiocarcinoma: a Case Report

Confinement to the intrapancreatic bile duct is independently associated with a better prognosis in extrahepatic cholangiocarcinoma

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