Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial

Clinical Characteristics and Treatment Outcomes of Patients with Unresectable Cholangiocarcinoma in Thailand: Are there Differences Dependent on Stent Type?

“…The number of patients in our study was not significantly different from those in retrospective studies by Nagino et al (2008) and Kawakami et al (2011), in which the overall median survival times were approximately 5-9 months. This result was substantially different from that of a prospective randomized control trial from Thailand by Sangchan et al (2012) that reported a median survival time for unresectable CCA of only 1.3-4 months. Based on the aforementioned data, we hypothesized that the difference in the etiology of CCA between Western and Asian countries or in different parts of Thailand (primary sclerosing cholangitis and parasitic infestation respectively) including disease severity might reasonably explain the discordant median survival times of patients worldwide.…”

“…In Khonkaen, the region that reported the highest incidence of CCA, including Opisthorchis viverrini infestation in 15.7% of cases, intrahepatic and extrahepatic CCA comprised 40% and 60% of the cases, respectively. The patients with distal CCA had better clinical outcomes than those with hilar or intrahepatic CCA (Aslanian and Jamidar, 2011;Sangchan et al, 2012;Anderson et al, 2012;Ruys et al, 2012).…”

“…In Western countries, approximately 60-70% of cases of CCA were reported to be hilar CCA, whereas distal and intrahepatic CCA comprised 20-30 and 5-10% of cases, respectively (Nagino et al, 2008;Akamatsu et al, 2011;Sangchan et al, 2012;Anderson et al, 2012). In Khonkaen, the region that reported the highest incidence of CCA, including Opisthorchis viverrini infestation in 15.7% of cases, intrahepatic and extrahepatic CCA comprised 40% and 60% of the cases, respectively.…”

“…Although the incidence was only 0.58-0.88 per 100,000 people in the USA, some particular endemic areas in Southeast Asia, especially northeastern Thailand, reported incidences as high as 39.4 and 94.8 per 100,000 people for females and males, respectively (Ruys et al, 2012;Sangchan et al, 2012). However, the incidence in Western countries had gradually risen in recent decades (Aslanian and Jamidar, 2011).…”

“…Chemotherapy is not effective for palliative treatment in advanced cases; therefore, the median survival of patients with unresectable CCA was only 3-13 months (Nagino et al, 2008;Akamatsu et al, 2011;Van der Gaag et al, 2012). Regarding the data of poor treatment outcomes for unresectable CCA despite adjuvant chemotherapy or radiation treatment (Shin et al, 2010;Aslanian and Jamidar, 2011;Sangchan et al, 2012;Ruys et al, 2012), many patients preferred only palliative treatment, particularly biliary drainage. However, there are only a few reports of the clinical outcomes of this particular group of patients at present.…”