One‐stage Resection for Bismuth Type IV Hilar Cholangiocarcinoma with High Hilar Resection and Parenchyma‐preserving Strategies: A Cohort Study

Tan, Jing; Hu, Ben Shun; Chu, Ya Juan; Tan, Yun Chang; Ji, Xu; Chen, Ke; Ding, Xiang; Zhang, Aiqun; Chen, Fei; Dong, Jia Hong

doi:10.1007/s00268-012-1878-4

Cited by 22 publications

(27 citation statements)

References 51 publications

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“…While resection represents the curative therapeutic option, less than 25% of patients are likely to undergo resection (Hamdani et al, 2012;Tan et al, 2013). Otherwise, most of the patients present with unresectable or metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Two-Week Combination Chemotherapy with Gemcitabine, High-Dose Folinic Acid and 5 Fluorouracil (GEMFUFOL) as First-Line Treatment of Metastatic Biliary Tract Cancers

Ünal

Öztop²,

Ünek³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: The aim of this study was to evaluate the efficacy and tolerability of a gemcitabine, 5-fluorouracil and leucovorin (GEMFUFOL) chemotherapy regimen as first line treatment of metastatic biliary tract cancer. Materials and Methods: All patients received folinic acid 400 mg/m 2 on day 1, 5-fluorouracil bolus 400 mg/ m 2 on day 1, IV infusion of 5-fluorouracil 2400 mg/m 2 over 46 hours, and gemcitabine 1250 mg/m 2 on day 1. Results: A total of 29 patients with metastatic biliary tract cancer received GEMFUFOL regimen as the firstline treatment. The mean follow-up was 22.1 months (95%CI, 12.5-31.8). One patient (3.4%) achieved complete response, 5 (17.2%) had partial response, and 4 (13.8%) had stable disease. The median progression-free survival was 3.3 months (95%CI, 2.9-3.7), and the median overall survival was 8.8 months (95%CI, 3.5-14). The 1-year and 2-year survival rates were 58.6% and 30%, respectively. Grade 3 and 4 toxicity included neutropenia in 4 patients (13.7%), thrombocytopenia in 2 (6.8%), anemia in 2 (6.8%), and alopecia in 1 (3.4%). Two patients (6.8%) developed febrile neutropenia. A dose reduction was achieved in 8 patients (27.6%) while 5 patients had extended-interval dosage (17.2%) for toxicity. Conclusions: The GEMFUFOL chemotherapy regimen was generally efficacious and tolerable as a first-line treatment of metastatic biliary tract cancer.

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Section: Introductionmentioning

confidence: 99%

Two-Week Combination Chemotherapy with Gemcitabine, High-Dose Folinic Acid and 5 Fluorouracil (GEMFUFOL) as First-Line Treatment of Metastatic Biliary Tract Cancers

Ünal

Öztop²,

Ünek³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Safety of major liver resections in jaundiced patients without preoperative biliary drainage were previously described in several studies (54)(55)(56)(57)(58)(59). However, there are also studies that have shown increased overall morbidity (60,61), bile leak (61) or intraabdominal abscesses rates (62) in jaundiced patients with major hepatectomies, albeit no differences of mortality rates were observed (61).…”

Section: Discussion Discussionmentioning

confidence: 94%

“…Recent systematic reviews have suggested that in patients with PHC, portal vein embolization should be used after biliary drainage when the future liver remnant volume is less than 40% (71,73). Some surgical teams consider portal vein embolization in PHC when the future liver remnat volume is ≤ 30% (57,(78)(79)(80). Nevertheless, recently it was proposed a score to calculate the risk of post-hepatectomy liver failure to better select the patients who may benefit from portal vein embolization (80).…”

Section: Discussion Discussionmentioning

confidence: 99%

Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Dumitraşcu¹,

Brasoveanu²,

Stroescu³

et al. 2018

SGO

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Introduction:The knowledge of current approach and outcomes of curative-intent surgery for perihilar cholangiocarcinoma (PHC) has been highlighted in studies of the literature including mainly East Asian and Western patients. Thus, papers presenting the curative-intent surgery in East Europe are scarce. The study aims to present the operative management and outcomes of curative-intent surgery for PHC in an East European institutional experience. Patients and methods: The data of all patients with curative-intent surgery for PHC between 1996 and 2017 were retrospectively reviewed from a prospective maintained electronic database at our Department of Surgery. The assessment was made for the operative management and early and late outcomes. Results: Liver resections were performed in 80.7% of patients, with caudate lobectomies in 64.7% of cases. Vascular resections were performed in 19.4% of patients. Preoperative biliary drainage was performed in 26% of patients. Negative resection margins were obtained in 76.7% of patients. Overall and severe morbidity rates were 57.3% and 24%, respectively. Postoperative bile leak, liver failure and hemorrhage rates were 31.3%, 24.7% and 10%, respectively. The 90-day mortality rate was 6%. The median overall and disease-free survival times were 26 months and 21 months, respectively. Conclusion: The standard approach for curative-intent surgery for PHC implies bile duct resection associated with major hepatectomies, including caudate lobectomy. Expertise in referral surgical centers of East Europe is associated with morbidity, mortality and overall survival rates comparable with those reported in Western centres, despite low rate of preoperative biliary drainage and no use of portal vein embolization. Improvements of preoperative optimization with portal vein embolization and biliary drainage may potentially lead to better early and long-term outcomes.

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“…For hilum cholangiocarcinoma without distant metastasis, resectable tumors present the possibility of resection of the involved intra-and extrahepatic bile ducts as well as the associated hepatic lobes and caudate lobe. Some recent reports have shown excellent results after surgical resection in patients with Bismuth III and IV disease [22,23], but the surgical management of these patients is still under debate.…”

Section: Resectable Malignancymentioning

confidence: 99%

Current Endoscopic Management of Malignant Biliary Stricture

et al. 2020

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Biliary and pancreatic cancers occur silently in the initial stage and become unresectable within a short time. When these diseases become symptomatic, biliary obstruction, either with or without infection, occurs frequently due to the anatomy associated with these cancers. The endoscopic management of these patients has changed, both with time and with improvements in medical devices. In this review, we present updated and integrated concepts for the endoscopic management of malignant biliary stricture. Endoscopic biliary drainage had been indicated in malignant biliary obstruction, but the concept of endoscopic management has changed with time. Although routine endoscopic stenting should not be performed in resectable malignant distal biliary obstruction (MDBO) patients, endoscopic biliary drainage is the treatment of choice for palliation in unresectable MDBO patients. Self-expanding metal stents (SEMS) have better stent patency and lower costs compared with plastic stents (PS). For malignant hilum obstruction, PS and uncovered SEMS yield similar short-term outcomes, while a covered stent is not usually used due to a potential unintentional obstruction of contralateral ducts.

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One‐stage Resection for Bismuth Type IV Hilar Cholangiocarcinoma with High Hilar Resection and Parenchyma‐preserving Strategies: A Cohort Study

Cited by 22 publications

References 51 publications

Two-Week Combination Chemotherapy with Gemcitabine, High-Dose Folinic Acid and 5 Fluorouracil (GEMFUFOL) as First-Line Treatment of Metastatic Biliary Tract Cancers

Two-Week Combination Chemotherapy with Gemcitabine, High-Dose Folinic Acid and 5 Fluorouracil (GEMFUFOL) as First-Line Treatment of Metastatic Biliary Tract Cancers

Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Current Endoscopic Management of Malignant Biliary Stricture

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