Preoperative biliary drainage for biliary tract and ampullary carcinomas

Abstract

We posed six clinical questions (CQ) on preoperative biliary drainage and organized all pertinent evidence regarding these questions. CQ

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.…”

“…This study compared the clinical manifestations of different CCA types in an Eastern population, and similar comparisons in Western populations were reported previously. This study revealed that weight loss occurs in as many as 85.8% of patients with CCA in Eastern populations, compared with a rate of 35% in Western populations, but the brush cytology positivity rate was similar between Eastern and Western populations (42.6% vs. 9-24%) (Klatskin, 1965;Nagino et al, 2008;Friman, 2011;Kawakami et al, 2011;Moon and Choi, 2011;Khan et al, 2012). In this study, serum CA19-9 levels exceeding 100 U/mL were detected in 54.0% of the patients.…”

“…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 advances in radical surgical treatment in resectable cases of this malignancy improved the clinical outcomes, the 5-year survival rate was only 25-43%. 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.…”

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

“…The Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) published the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008 [1][2][3][4][5][6][7][8][9][10]. This was the only clinical guidelines focused on these complicated diseases and contributed to provide general and specialized clinicians with knowledge on standard treatments.…”