Segment III Cholangiojejunostomy for Carcinoma of the Gallbladder

Chaudhary, Adarsh; Dhar, Puneet; Tomey, Sudhir; Sachdev, A; Agarwal, Anil

doi:10.1007/s002689900319

Cited by 22 publications

(13 citation statements)

References 11 publications

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“…The SGPGIMS group had earlier reported its experiences with intrahepatic segment III cholangio‐jejunostomy in patients with advanced GBC; this procedure provided excellent palliation of jaundice, pruritus, and cholangitis, with acceptable morbidity and mortality . Similar good results with segment III bypass have been reported by the Tata Memorial Hospital, Mumbai and the GB Pant Hospital, New Delhi . In patients with mucocele due to GB neck mass, the distended GB may also be drained into the jejunal Roux loop .…”

Section: Palliationmentioning

confidence: 67%

Advanced gallbladder cancer: Indian “middle path”

Kapoor

2007

J Hepatobiliary Pancreat Surg

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Gallbladder cancer (GBC) is common in northern India. The western world has a pessimistic attitude towards GBC resulting in inadequate management of even early GBC. At the other extreme is the Japanese aggressivism with high mortality but very few actual long-term survivors. The Indian surgeons have adopted a Buddhist "middle path"--aggressive surgical approach for "less advanced" GBC and non-surgical palliative approach for "more advanced" GBC. We rely heavily on staging laparoscopy to detect metastatic deposits on liver, peritoneum and omentum, and upper gastrointestinal endoscopy (UGIE) to detect duodenal infiltration which indicates unresectability as we do not perform pancreatico-duodenectomy for GBC. Our favoured procedure is extended cholecystectomy (EC) which includes a 2 cm nonanatomical wedge of liver in the GB bed and the lymph nodes in hepatoduodenal ligament, behind the duodenum and head of pancreas and along the hepatic artery to the right of celiac axis. EC can achieve R0 resection in patients with T1-T2 and T3 (fundus/body--hepatic bed type) disease. For T3 (neck--hepatic hilum type) and T4 disease major hepatic resection is required. In selected patients with nodally advanced GBC, a non-curative simple cholecystectomy with post-operative chemoradiotherapy may improve survival. GBC is an "Indian disease" and Indian surgeons have to be prepared to accept the "challenge" of GBC.

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Section: Palliationmentioning

confidence: 67%

Advanced gallbladder cancer: Indian “middle path”

Kapoor

2007

J Hepatobiliary Pancreat Surg

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“…Surgical decompression of the biliary tract involves a hepatico-jejunostomy, which has a 30 day post-operative mortality rate between 7% and 24%. [16][17][18][19] Recovery time is a limiting factor in quality of life improvement in a majority of patients who undergo surgery. [20][21][22] Presently, biliary decompression is most frequently accomplished through endoscopic biliary stent placement.…”

Section: -9mentioning

confidence: 99%

Photodynamic Therapy for Cholangiocarcinoma

Talreja

Kahaleh

2010

Gut Liver

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Cholangiocarcinoma is the primary malignancy arising from the biliary epithelium, and it presents as jaundice, cholestasis, and cholangitis. Over 50 percent of patients present with advanced-stage disease, and the prognosis is poor with the survival measured in months even after biliary decompression. Palliative management has become the standard of care for unresectable disease, and this involves an endoscopic approach. Photodynamic therapy (PDT) involves the administration of a photosensitizer followed by local irradiation with laser therapy. The use of PDT for palliation of bile-duct tumors has produced promising results. Several studies conducted in Europe and the United States have shown that PDT produces a marked improvement in the symptoms of cholestasis, survival, and quality of life. This chapter summarizes the principle of PDT, the technique employed, and the published experience regarding PDT for cholangiocarcinoma. (Gut Liver 2010;4(Suppl. 1):S62-66)

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“…In ausgewählten Fällen ist eine Segment-III-Cholangiojejunostomie für die Cholestasebeseitigung indiziert [144,145]. Ein Ansprechen auf eine perkutane Strahlentherapie ist nur in etwa 20 % der Fälle zu erwarten.…”

Section: Gallenblasenkarzinomeunclassified

Aktuelle Diagnostik und Therapie von Gallengangs- und Gallenblasenkarzinomen

Wiedmann

Schoppmeyer²,

Witzigmann³

et al. 2005

Z Gastroenterol

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Carcinoma of the biliary tree are rare tumours of the gastrointestinal tract with a rising incidence during the last years. Biliary neoplasms are classified into intra- and extrahepatic cholangiocarcinoma (Klatskin tumour, middle and distal extrahepatic tumours), gallbladder cancer, and ampullary carcinoma. Transformation of normal into malignant bile duct tissue requires a chain of consecutive gene mutations, similar to the adenoma-dysplasia-carcinoma-sequence in colon cancer. Abdominal ultrasound, combined non-invasive magnetic resonance cholangiography/tomography (MRC/MRT), and facultatively endoscopic retrograde cholangiography (ERC) for unclear diagnosis, represent the gold standard for primary diagnosis. For ampullary carcinoma, endosonography and endoscopic biopsy are the diagnostic tools of choice. Cure is attainable only by formal curative radical surgical resection. Increasing surgical radicality within the last years enabled clearly improved 5-year survival rates. In contrast, there has been no clinical benefit for adjuvant and neoadjuvant therapies. For palliation, bile duct stenting and photodynamic therapy are established methods. Radio- and chemotherapy should be reserved for clinical studies. New therapeutic approaches include brachytherapy, the use of modern chemotherapeutics, COX-2- and tyrosine kinase-receptor-inhibitors.

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Segment III Cholangiojejunostomy for Carcinoma of the Gallbladder

Cited by 22 publications

References 11 publications

Advanced gallbladder cancer: Indian “middle path”

Advanced gallbladder cancer: Indian “middle path”

Photodynamic Therapy for Cholangiocarcinoma

Aktuelle Diagnostik und Therapie von Gallengangs- und Gallenblasenkarzinomen

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