Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Abstract

Background The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. Methods Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidencebased approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. Results The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. Conclusions This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via

Preoperative biliary drainage versus direct surgery for perihilar cholangiocarcinoma: A retrospective study at a single center

“…The rate of vascular resection and reconstruction in PBD group was higher in their study, but in our study the rate was lower. In our center, as the value of resection and reconstruction of portal vein or hepatic artery (stage IV, AJCC 7 th staging system) is still controversial (22), so some of those patients at the current authors' Hospital wished to undergo chemotherapy rather than surgery for financial reasons. In addition, staging was more precise in the PBD group resulting in more patients with stage IV cancer were detected and ruled out in this study.…”

Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice

“…We perform preoperative biliary drainage at our hospital in accordance with the preoperative management of biliary tract cancer. 22 Biliary drainage of the remnant liver is performed until the serum bilirubin is < 2 mg/dl because a higher level than this is a contraindication for hepatectomy according to Makuuchi's criteria, and hepatectomy is performed if the functional liver reserve is sufficient. 23 In our present study, perioperative outcomes were similar between the groups depending on the presence or absence of preoperative jaundice.…”

Incidental Gallbladder Cancer

“…The recurrence rate after simple cholecystectomy is higher than that after extended cholecystectomy (12.5 vs. 2%, respectively) [41,50]. However, this survival beneit has been debated in the literature, and simple cholecystectomy is considered suicient for GBC T1b, especially in eastern countries [51]. Bile duct resection is indicated in cases with a positive cystic duct margin, since recurrence occurs in 50% of these cases.…”

“…Another indication is hepatoduodenal ligament invasion (GB neck tumor) as part of en bloc oncologic resection [43,45,51]. In these cases, complete removal of the bile duct is necessary, with further reconstruction using a Roux-en-Y hepaticojejunostomy technique.…”