Cholangiocarcinoma of the extrahepatic bile ducts

Jarnagin, William R.

doi:10.1002/1098-2388(200009)19:2<156::aid-ssu8>3.0.co;2-#

Cited by 104 publications

(55 citation statements)

References 108 publications

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“…Only 10% of cases present with ascending cholangitis [70] . Jaundice is usually persistent and progressive while intermittent biliary obstruction may be observed in patients with papillary lesions that cause a ball-valve effect [71] . Physical examination of patients with CC may reveal hepatomegaly, palpable gallbladder (Courvoisier sign), or signs of portal hypertension due to portal vein thrombosis secondary to tumor invasion or compression [33,69] .…”

Section: Clinical Presentationmentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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Section: Clinical Presentationmentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

View full text Add to dashboard Cite

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“…[3][4][5][6][7][8][9] The only effective treatment for the distal EBD carcinomas is a complete surgical resection. 3,6,7 After complete resection of the distal EBD carcinomas, 5-year survival rate was reported to be 15-45%, while the median survival time of the patients having the palliative bypass surgery or biliary stent was reported to be less than 1 year. 3,6,7,[15][16][17][18] The patients with the EBD carcinomas are known to have a poor survival when pancreatic invasion is present.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,7 After complete resection of the distal EBD carcinomas, 5-year survival rate was reported to be 15-45%, while the median survival time of the patients having the palliative bypass surgery or biliary stent was reported to be less than 1 year. 3,6,7,[15][16][17][18] The patients with the EBD carcinomas are known to have a poor survival when pancreatic invasion is present. 10,11 In the present study, we classified the distal EBD carcinomas according to the degree of the pancreatic invasion and compared the survival rate of each class.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The EBD carcinomas originating from the lower to middle portions of the bile duct (distal EBD carcinoma) are composed of 20-30% of the entire EBD carcinomas. [3][4][5][6][7][8][9] The pancreatic invasion of the EBD carcinomas has been known to be a bad prognostic sign. 10,11 However, we experienced that several patients with the EBD carcinoma with superficial pancreatic invasion had a more favorable survival outcome than we expected.…”

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Superficial vs deep pancreatic parenchymal invasion in the extrahepatic bile duct carcinomas: a significant prognostic factor

et al. 2005

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Pancreatic invasion of the extrahepatic bile duct (EBD) carcinomas is known to have a poor outcome. We hypothesized that EBD carcinoma showing shallow invasion to the pancreas may have a better outcome than the usual deep pancreatic invasion. We divided 87 cases of the distal EBD carcinomas into superficial and deep pancreatic invasion groups according to degrees of the pancreatic invasion. The superficial pancreatic invasion group included cases with tumor abutting the pancreatic lobule or pancreatic parenchymal invasion equal to or less than 1 mm from the uppermost portion of the pancreatic lobule or tumors invading into the fibroadipose tissue between pancreatic lobules without parenchymal invasion. The deep invasion group consisted of tumors with more than 1 mm pancreatic parenchymal invasion. The cases with superficial pancreatic invasion showed significantly better survival rate than those with deep pancreatic invasion (Po0.001). Therefore, we recommend that a specific remark on the pathology report about the presence or absence of parenchymal invasion and the depth of invasion of the pancreas is required for managing patients and determining the prognosis. We also recommend that the current pT3 stage of distal EBD carcinomas be subdivided into superficial (pT3a) and deep pancreatic invasion (pT3b). Modern Pathology (2005) 18, 969-975.

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“…4 Invasion into the main portal vein, common hepatic artery, or into 1 lobe of the liver with invasion of the contralateral branch of the portalvein or hepatic artery are criteria for unresectability. 9,10 In an analysis of various studies about survival after LT for cholangiocarcinoma, Castaldo and associates 11 showed that 5-year OS rates were between 0% and 42% (range, 0%-83%). The group established that cholangiocarcinoma is a poor indication in general for transplant due to high disease recurrence with few long-term survivors.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Haberal

2017

Exp Clin Transplant

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Liver transplant is now an acceptable and effective treatment for specific nonhepatocellular malignancies. Worldwide, hilar cholangiocarcinoma accounts for 3% of all primary gastrointestinal malignancies and for 10% of primary hepatobiliary malignancies. For patients who have early-stage, unresectable cholangiocarcinoma, liver transplant preceded by neoadjuvant radiotherapy can result in tumor-free margins, accomplish a radical resection, and treat the underlying primary sclerosing cholangitis when present. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin with a variable malignant potential. Excellent results have been reported with liver transplant for patients with unresectable hepatic epithelioid hemangioendothelioma, with 1-year and 10-year survival rates of 96% and 72%. Hepatoblastoma is the most common primary hepatic malignancy in children. The long-term survival rate after transplant ranges from 66% to 77% in patients with unresectable tumors and good response to chemotherapy. Metastatic liver disease is not an indication for liver transplant, with the exception of cases in which the primary tumor is a neuroendocrine tumor. Indication for liver transplant for hepatic metastasis from neuroendocrine tumors is mainly for patients with unresectable tumors and for palliation of medically uncontrollable symptoms. Posttransplant survival in those patients with low tumor activity index is excellent, despite recurrence of the tumor. Some recent data on liver transplant for unresectable hepatic metastases from colorectal cancer have reported limited survival benefits compared with previous reports. However, due to the high rate of tumor recurrence in a very short time after liver transplant, especially in the era of organ shortage, this indication has not been favored by the transplant community. The indications for liver transplant for nonhepatocellular carcinoma malignancy and its limitations have evolved dramatically over the past decades and will continue to be redefined through future research and investigations.

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Cholangiocarcinoma of the extrahepatic bile ducts

Cited by 104 publications

References 108 publications

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Superficial vs deep pancreatic parenchymal invasion in the extrahepatic bile duct carcinomas: a significant prognostic factor

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