Current surgical treatment for bile duct cancer

Seyama, Yousuke; Makuuchi, Masatoshi

doi:10.3748/wjg.v13.i10.1505

Cited by 106 publications

(77 citation statements)

References 90 publications

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“…Especially, regional lymphadenectomy has been recognized recently as the standard curative treatment for extrahepatic bile duct cancer [6]. Therefore, we evaluated the influence of incomplete en bloc LN dissection on patients undergoing PD for mid-to-distal CBD cancer when aberrant RHA arose from SMA or GDA, or CA.…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of an Aberrant Right Hepatic Artery in Patients Undergoing Pancreaticoduodenectomy

Lee

Kim

et al. 2009

World j. surg.

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Background Sometimes, it seems to be difficult to preserve the aberrant hepatic artery (HA) during pancreaticoduodenectomy (PD), with respect to en bloc lymph node dissection, especially in the case of aberrant right hepatic artery (RHA). Therefore, we evaluated the influence of incomplete en bloc lymph node (LN) dissection when aberrant RHA arises. Methods We reviewed 103 patients with mid-to-distal common bile duct (CBD) cancers who underwent PD by one surgeon at Asan Medical Center from December 1994 to November 2005 (73 men, 30 women; mean age, 61.1 ± 9.4 (range: 40-84) years). The mean follow-up period was 32.7 months. We compared the normal RHA group with the aberrant RHA group. Results Eighty-eight cases showed normal RHA anatomy, including nine cases (8.7%) of aberrant left hepatic artery (LHA) with normal RHA cases (normal HA group). RHA anomalies were observed in 15 cases (14.6%, aberrant HA group). In all cases, there was no direct invasion of cancer to aberrant HA. Among two groups, 43 cases (41.7%) showed recurrence and there was no significant difference in recurrence between two groups (p = 0.202). Three-year and 5-year overall survivals were 33.3% and 28.5% in the normal HA group, whereas 47.1% and 28.3% in the aberrant RHA group, respectively. There also was no statistically significant difference in survival (p = 0.763). Conclusions When performing PD for CBD cancer, aberrant RHA should be preserved if there was no cancerous invasion and it does not seem to affect the recurrence of disease and overall survival of patients.

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Section: Introductionmentioning

confidence: 99%

Clinical Implications of an Aberrant Right Hepatic Artery in Patients Undergoing Pancreaticoduodenectomy

Lee

Kim

et al. 2009

World j. surg.

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“…Surgery is associated with 5-year survival rates of 24 -40% (Seyama and Makuuchi, 2007), but more than 80% of patients are considered unresectable at the time of diagnosis (Jarnagin et al, 2001) and have a median survival of approximately 6 -9 months (Khan et al, 2002).…”

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confidence: 99%

MUC4 and MUC5AC are highly specific tumour-associated mucins in biliary tract cancer

et al. 2008

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Alterations in epithelial mucin expression are associated with carcinogenesis, but there are few data in biliary tract cancer (BTC). In pancreatic malignancy, MUC4 is a diagnostic and prognostic tumour marker, whereas MUC5AC has been proposed as a sensitive serological marker for BTC. We assessed MUC4 and MUC5AC expression in (i) prospectively collected bile and serum specimens from 72 patients with biliary obstruction (39 BTC) by real-time reverse transcriptase -PCR (qPCR) and western blot analysis, and (ii) 79 archived biliary tissues (69 BTC) by immunohistochemistry. In bile, MUC4 protein was detected in 27% of BTC and 29% of primary sclerosing cholangitis (PSC) cases, but not in other benign and malignant biliary diseases (Po0.01 and P ¼ 0.06). qPCR revealed a 1.9-fold increased MUC4 mRNA expression in BTC patients' bile compared with benign disease. In archived tissues, MUC4 protein was detected in 37% of BTC but in none of the benign samples (P ¼ 0.03). In serum, MUC5AC was found exclusively in BTC and PSC sera (44% and 13%, respectively; Po0.001 for BTC vs non-BTC) and correlated negatively with BTC survival. Biliary MUC4 and serum MUC5AC are highly specific tumour-associated mucins that may be useful in the diagnosis and formulation of therapeutic strategies in BTC.

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“…[18][19][20] In intrahepatic cholangiocarcinomas, extended hemihepatectomy with wide surgical margins has been recommended for curative treatment. 21 For liver metastases in the bile duct, the same strategy may be better because of the wide spread of carcinoma along the biliary lumen and infiltration to microvessels or lymph nodes, although limited resection is acceptable for usual metastatic liver tumor. 4,5,7,22 This type of liver metastasis, like intrahepatic cholangiocarcinoma, would be a good indication for extended surgical resection to achieve complete resection, resulting in a better prognosis.…”

Section: Discussionmentioning

confidence: 99%

Intraductal papillary growth of liver metastasis originating from colon carcinoma in the bile duct: Report of a case

et al. 2011

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Morphologically, liver metastases from colorectal carcinoma usually form as nodular tumor masses, whereas intra-ductal papillary growth in the bile duct is rare. A 65-year-old man underwent right hemi-colectomy for advanced colon carcinoma and histology of the primary carcinoma confirmed moderately differentiated adenocarcinoma with subserosal invasion, no vascular infiltration, and no lymph node metastasis. A liver tumor was found in the right paramedian Glisson's pedicle and intra-ductal growth of cholangiocarcinoma was seen on imaging. We performed right hepatectomy and macroscopically, the resected specimen contained a growth in the bile duct lumen similar to cholangiocarcinoma.Histological examination revealed intraductal papillary proliferation of well-differentiated adenocarcinoma without vascular infiltration or lymph node metastasis in the hepatic hilum. Immunohistochemical staining revealed that the tumor cells were negative for cytokeratin 7 and positive for cytokeratin 20. Based on these findings, liver metastasis from colon carcinoma was diagnosed. Liver metastasis from colorectal carcinoma rarely arises as intraductal papillary growth in the bile duct, but the possibility of liver metastases with unusual morphology must be borne in mind in patients with a history of carcinoma in the digestive tract.

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Current surgical treatment for bile duct cancer

Cited by 106 publications

References 90 publications

Clinical Implications of an Aberrant Right Hepatic Artery in Patients Undergoing Pancreaticoduodenectomy

Clinical Implications of an Aberrant Right Hepatic Artery in Patients Undergoing Pancreaticoduodenectomy

MUC4 and MUC5AC are highly specific tumour-associated mucins in biliary tract cancer

Intraductal papillary growth of liver metastasis originating from colon carcinoma in the bile duct: Report of a case

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