<p>The Significance of Adjuvant Therapy for Extrahepatic Cholangiocarcinoma After Surgery</p>

Abstract

Extrahepatic cholangiocarcinoma (EHCC) is a rare malignant tumor, and current treatment methods are also relatively limited. Radical surgery is the only potentially curative method for the long survival time. However, despite undergoing radical resection, prognosis remained poor due to the high recurrence rate and distant metastasis. Therefore, adjuvant chemotherapy and radiotherapy should be offered to patients who have undergone surgery. Unfortunately, the low incidence of this disease has resulted in a lack of high-level evidence to confirm the importance of adjuvant chemotherapy or radiotherapy. At present, it is still controversial whether adjuvant therapy can prolong the survival of patients after operation, especially patients with negative margins or lymph nodes. Furthermore, standard regimens of adjuvant have not been identified. This review summarizes the currently available evidence of the effect of adjuvant therapy in the management of EHCC. Ultimately, we concluded that adjuvant therapy may improve survival in high-risk (positive margin or lymph node or advanced stage) patients and adjuvant concurrent chemoradiotherapy followed by chemotherapy may be the optimum selection for them. This needs to be verified by randomized prospective clinical trials.

Analysis of Post-operative Adjuvant Chemotherapy Versus Adjuvant Chemoradiation Therapy Outcomes in Non-metastatic Cholangiocarcinoma: an NCDB Review

“…Corroborating this, a large case series of 920 patients treated with surgical resection for intrahepatic cholangiocarcinoma demonstrated 607 patients (66%) who developed recurrence of the disease [17]. Comparatively, in surgically resected perihilar and distal extrahepatic cholangiocarcinoma, the recurrence rate ranged from 60 to 75% [18]. Poor prognosis of this disease and the risk of recurrence following surgical resection in local stages illustrate the imperative need to consider adjuvant options for management.…”

Recognition and pathological features of periampullary region adenocarcinoma with an indeterminable origin

“…Although therapeutic strategies of DBDC, PDAC, and AmpC are partly similar, advances in adjuvant chemotherapy require a strict distinction between these carcinomas. For PDAC, multi‐agent chemotherapy such as modified FOLFIRINOX has become a standard; however, a standard adjuvant therapy for biliary tract cancer remains unclear 20‐22 . Therefore, determination of the primary tumor site in either PDAC or DBDC/AmpC in a standardized manner is becoming more important in patient management.…”

Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery

“…Patients who are lighter or have liver and kidney function abnormalities who are not carefully evaluated before surgery, may be given overdosed anesthetic drugs, which may lead to high drug concentration in the body and DR [40] . If the operation time is very long and the evaluation of the end of the operation is biased, the anesthesia duration will be too long accordingly, [41] which is also an important factor for occurrence of DR from anesthesia. It must be noted that patients with lower body temperature who enter the recovery room after surgery are more likely to develop DR [42] .…”

“…In the perioperative factors of DR from anesthesia, the main factors are the dosage of anesthetic drugs, the patient's body temperature and duration of surgery, and the amount of intraoperative fluid infusion. [39] Patients who are lighter or have liver and kidney function abnormalities who are not carefully evaluated before surgery, may be given overdosed anesthetic drugs, which may lead to high drug concentration in the body and DR. [40] If the operation time is very long and the evaluation of the end of the operation is biased, the anesthesia duration will be too long accordingly, [41] which is also an important factor for occurrence of DR from anesthesia. It must be noted that patients with lower body temperature who enter the recovery room after surgery are more likely to develop DR. [42] Drops in body temperature may decrease the activity of enzymes related to drug metabolism, which may cause drugs to accumulate in the body and patients experience DR. [43] Several limitations in this present study must be considered.…”