Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma

Jikei, Kosuke; Mizuno, Takashi; Kyokane, Takanori; Matsubara, Hideo; Yokoyama, Shinya; Kato, Kenji; Suzumura, Kiyoshi; Hashimoto, Masakazu; Kawai, Satoru; Nagino, Masato

doi:10.1245/s10434-020-09157-3

Cited by 13 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hepatopancreatoduodenectomy was indicated as a treatment for various modes of tumor spread that otherwise could not be completely removed 15,16 . Bile duct resection was indicated only for high‐risk patients with a limited tumor burden 17 . Combined vascular resection was performed when macroscopic vascular invasion was confirmed during the surgery 18,19 …”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Is a specific T classification needed for extrahepatic intraductal papillary neoplasm of the bile duct (IPNB) type 2 associated with invasive carcinoma?

Mitake

Onoe

Igami

et al. 2022

J Hepato Biliary Pancreat

Self Cite

View full text Add to dashboard Cite

Background The necessity of a specific T classification for extrahepatic intraductal papillary neoplasm of the bile duct (IPNB) type 2, one of the precursors of cholangiocarcinoma (CC), remains unclear. Methods Patients who underwent resection for extrahepatic biliary tumors were reviewed. Relapse‐free survival (RFS) was compared between IPNB type 2 and CC, stratified by T classification. Results The cohort involved 443 patients with IPNB type 2 (n = 57) and CC (n = 386). In 342 patients with perihilar tumors, 5‐year RFS of IPNB type 2 and CC group was 49.8% versus 34.5% (p = .012), respectively. The RFS was 54.6% versus 47.2% (p = .110) for pT1‐2 tumors and 28.6% versus 22.7% (p = .436) for pT3‐4 tumors, respectively. In 92 patients with distal tumors, 5‐year RFS was 47.4% versus 42.1% (p = .678). The RFS was 68.2% versus 49.6% (p = .422) for pT1 tumors and 18.8% versus 38.3% (p = .626) for pT2‐3 tumors, respectively. Multivariate analysis identified that poor histologic grade (HR, 2.105; p < .001), microscopic venous invasion (HR, 1.568; p = .002), and nodal metastasis (HR, 1.547; p < .001) were independent prognostic deteriorators, while tumor type (IPNB type 2 vs. CC) was not. Conclusions Prognostic impact of IPNB type 2 was limited, suggesting unnecessity of a specific T classification for IPNB type 2 with invasive carcinoma.

show abstract

Section: Methodsmentioning

confidence: 99%

“…15,16 Bile duct resection was indicated only for highrisk patients with a limited tumor burden. 17 Combined vascular resection was performed when macroscopic vascular invasion was confirmed during the surgery. 18,19…”

Section: Surgerymentioning

confidence: 99%

Is a specific T classification needed for extrahepatic intraductal papillary neoplasm of the bile duct (IPNB) type 2 associated with invasive carcinoma?

Mitake

Onoe

Igami

et al. 2022

J Hepato Biliary Pancreat

Self Cite

View full text Add to dashboard Cite

show abstract

“…This may be because sarcomatoid tumors are often nodular in shape and well-circumscribed and BDR may more easily achieve a cancer-negative margin, in contrast to biliary adenocarcinoma, which often spreads widely along the bile duct. Previous case reports showed that segmental BDR for middle bile duct cancer resulted in less postoperative morbidity, but a worse prognosis than these major surgeries [26][27][28]. Therefore, BDR needs to be considered for patients with a poor general condition.…”

Section: Discussionmentioning

confidence: 99%

Aggressive behavior of anaplastic undifferentiated carcinoma arising from the hilar bile duct

et al. 2022

View full text Add to dashboard Cite

Background Undifferentiated carcinoma of the biliary tree is extremely rare, and biliary undifferentiated carcinoma mostly originates from the gallbladder. We herein present a case of anaplastic undifferentiated carcinoma of the hilar bile duct and reviewed the literature. Case presentation The patient was an 81-year-old male with obstructive jaundice. Contrast-enhanced computed tomography (CT) showed a protruded tumor located at the hepatic hilum. Obstructive jaundice was relieved by endoscopic drainage. Endoscopic biopsy revealed carcinoma without glandular differentiation, and the patient was diagnosed with resectable hilar undifferentiated carcinoma. During the 5-week preoperative examination, the tumor increased in size from 23 to 45 mm. Left hemi-hepatectomy and extrahepatic bile duct resection were performed, and there were no postoperative complications. Histological findings demonstrated that the tumor was mainly composed of non-cohesive polygonal neoplasms with pleomorphic nuclei, and was diagnosed as anaplastic undifferentiated carcinoma of the common hepatic duct (T2a N0 M0 Stage II). One month after surgery, the patient was readmitted to our hospital with pyrexia due to cholangitis, and liver nodules suggestive of multiple liver metastases were detected by CT. Three months after surgery, the patient died of multiple liver metastases. Conclusions This is the first case report of undifferentiated cholangiocarcinoma with anaplastic features. Anaplastic undifferentiated carcinoma of the hilar bile duct showed preoperative rapid growth and early relapse despite a cancer-negative surgical margin.

show abstract

“…23,24 Extrahepatic tumors were more likely to be treated among the rst quartile of patients, which may be a result of differences in surgical techniques and associated recovery times between tumor locations. [25][26][27] We also identi ed some predictors of delay that were less expected, including treatment with RT alone as well as black and Hispanic race. As RT alone is not a guideline-supported option for adjuvant therapy, patients treated with RT alone may represent a cohort that is unable to recover adequately from surgery to be treated with CT or CRT.…”

Section: Discussionmentioning

confidence: 99%

The Implications of Treatment Delays In Adjuvant Therapy For Resected Cholangiocarcinoma Patients

Parsons

Lloyd

Johnson

et al. 2021

Preprint

View full text Add to dashboard Cite

Purpose: To understand factors associated with timing of adjuvant therapy for cholangiocarcinoma and the impact of delays on overall survival (OS).Methods: Data from the National Cancer Database (NCDB) for patients with non-metastatic bile duct cancer from 2004 to 2015 were analyzed. Patients were included only if they underwent surgery and adjuvant chemotherapy and/or radiotherapy (RT). Patients who underwent neoadjuvant or palliative treatments were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients initiating therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling.Results: In total, 7,733 of 17,363 (45%) patients underwent adjuvant treatment. The median time to adjuvant therapy initiation was 59 days (interquartile range 45-78 days). Age over 65, black and Hispanic race, and treatment with RT alone were associated with later initiation of adjuvant treatment. Patients with larger tumors and high grade disease were more likely to initiate treatment early. After propensity score weighting, there was an OS decrement to initiation of treatment beyond the median of 59 days after surgery. Conclusions: We identified characteristics that are related to the timing of adjuvant therapy in patients with biliary cancers. There was an OS decrement associated with delays beyond the median time point of 59 days. This finding may be especially relevant given the treatment delays seen as a result of COVID-19.

show abstract

Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma

Cited by 13 publications

References 29 publications

Is a specific T classification needed for extrahepatic intraductal papillary neoplasm of the bile duct (IPNB) type 2 associated with invasive carcinoma?

Is a specific T classification needed for extrahepatic intraductal papillary neoplasm of the bile duct (IPNB) type 2 associated with invasive carcinoma?

Aggressive behavior of anaplastic undifferentiated carcinoma arising from the hilar bile duct

The Implications of Treatment Delays In Adjuvant Therapy For Resected Cholangiocarcinoma Patients

Contact Info

Product

Resources

About