Latest Research on Bile Duct Cancer : Nov 2020

Outcome of treatment for distal bile duct cancer

All patients with distal bile duct tumours over a 10‐year period (October 1983 to December 1993) were identified by means of a prospective database. The medical records of 104 patients were reviewed. Univariate and multivariate analysis for predictors of outcome was performed. Median age of the patients was 65 (range 30–89) years. Patients presented with a clinical picture indistinguishable from that of pancreatic ductal adenocarcinoma. Twenty patients had no surgical treatment and 23 had a diagnostic laparotomy only. Biliary bypass was performed in 16 patients and radical resection was performed in 45 (pancreaticoduodenectomy, 39; bile duct excision, six). Operative mortality occurred in two of 45 patients having radical resection and complications in 17. Resection provided significant survival benefit. By univariate and multivariate analysis, resectability and negative node status (P < 0‐001) were the only predictors of favourable outcome. Sex, age, preoperative stenting, grade of tumour and bilirubin level did not predict outcome. The 5‐year survival rate for radically resected, node‐negative tumours was 54 per cent. Surgical resection is effective therapy for distal bile duct tumours. These patients have a better outlook than those having resection of pancreatic adenocarcinoma. [1]

Surgical treatment in proximal bile duct cancer. A single-center experience

OBJECTIVES: The authors evaluated the experience and results of a single center in surgical treatment of proximal bile duct carcinoma. SUMMARY BACKGROUND DATA: Whenever feasible, surgery is the appropriate treatment in proximal bile duct carcinoma. To improve survival rates and with special regard to liver transplantation, the extent of surgical radicalness remains an open issue. PATIENTS AND METHODS: Retrospective analysis of 249 patients who underwent surgery for proximal bile duct carcinoma via the following procedures: resection (n = 125), liver transplantation (n = 25), and exploratory laparotomy (n = 99). Survival rates were calculated according to the Kaplan-Meier method, uni- and multivariate analysis of prognostic factors, and log rank test (p < 0.05). RESULTS: Survival rates after resection and liver transplantation are correlated with international Union Against Cancer (UICC) tumor stage (resection: overall 5-year, 27.1%; stage I and II, 41.9%; stage IV, 20.7%; liver transplantation: overall 5-year, 17.1%; stage I and II, 37.8%; stage IV, 5.8%). Significant univariate prognostic factors for survival after liver resection were lymph node involvement (N category), tumor stage, tumor-free margins, and vascular invasion; for transplantation, they were local tumor extent, N category, tumor stage, and infiltration of liver parenchyma. For resection and transplantation, a multivariate analysis showed prognostic significance of tumor stage and tumor-free margins. CONCLUSION: Resection remains the treatment of choice in proximal bile duct carcinoma. Whenever possible, decisions about resectability should be made during laparotomy. With regard to the observation of long-term survivors, liver transplantation still can be justified in selected patients with stage II carcinoma. It is unknown whether more radical procedures, such as liver transplantation combined with multivisceral resections, will lead to better outcome in advanced stages. With regard to palliation, surgical drainage of the biliary system performed as hepatojejunostomy can be recommended. [2]

Current surgical treatment for bile duct cancer

Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD (hepatopancreatoduodenectomy) has been applied to selected patients with widespread tumors. Preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer. [3]

Focal Caroli’s Disease Presenting as Fusiform Dilatation of Intrahepatic Biliary Radicles

Background Caroli’s disease is a rare congenital disorder characterized by segmental, non obstructive, cystic dilatation of intra hepatic bile ducts. It belongs to the spectrum of fibropolycystic liver disease which results from in utero malformation of ductal plate. Two forms of this disorder have been described, the less common ‘Pure’ form involves only the large intrahepatic bile ducts and the more ‘complex’ form is associated with congenital hepatic fibrosis (CHF), and is known as Caroli’s Syndrome. Case A young female presented with features of cholangitis and in addition to all the routine investigations, non invasive imaging in the form of ultrasonography, computed tomography and magnetic resonance imaging was done. Diagnosis Final diagnosis of focal Caroli’s disease with cholangitis was made on clinical and imaging findings. Treatment Conservative treatment was given and patient referred to gastro surgery department for partial hepatectomy. Conclusion An early recognition of Caroli’s disease with non invasive imaging can bring down the morbidity. [4]

Somatostatin Infusions Reduce Post-Operative Bile Leak after Hepatopancreatobiliary Surgery: An Observational Preliminary Study

Background: Bile leak is a complication of hepatopancreatobiliary surgery and results from injury to the bile ducts. Treatment usually consists of percutaneous drainage combined with the placement of a biliary stent or a nasobiliary draining tube in the biliary tree via endoscopic retrograde cholangiopancreatography. Animal experiments and studies in humans have shown that somatostatin reduces bile secretion.

Objective: To evaluate the efficacy of somatostatin as a conservative monotherapy for the successful management of mild to moderate post-operative bile leak.

Place and Duration of Study: 2nd Department of at the University General Hospital of Alexandroupolis, during the period of 2010 and 2012.

Patients and Methods: Fifteen patients (11male/4 female) with a mean age of 70.1±4.2 years who developed uncomplicated post-operative bile leak with a daily output ranging from 100ml to 800ml were included in the study. Eleven patients were operated for benign diseases of the liver and biliary tract, while the rest 4 patients for pancreatic or biliary tract malignancies. Somatostatin was administered intravenously to all patients in continuous infusions of 3000μg/12hours until complete recession of bile leak along with total parenteral nutrition.

Results: Somatostatin treatment was successful in 14 patients (93.3%), with success being defined as the complete cessation of bile leak. Overall, mean duration of bile leak was 13.8±3.9 days. No major adverse reactions or complications were observed and no patients died.

Conclusions: Somatostatin appears to be effective in the treatment of post-operative bile leak. The efficacy of somatostatin is observed both in patients with benign or malignant disease. [5]

Reference

[1] Fong, Y., Blumgart, L.H., Lin, E., Fortner, J.G. and Brennan, M.F., 1996. Outcome of treatment for distal bile duct cancer. British journal of surgery, 83(12), pp.1712-1715.

[2] Pichlmayr, R., Weimann, A., Klempnauer, J., Oldhafer, K.J., Maschek, H., Tusch, G. and Ringe, B., 1996. Surgical treatment in proximal bile duct cancer. A single-center experience. Annals of surgery, 224(5), p.628.

[3] Seyama, Y. and Makuuchi, M., 2007. Current surgical treatment for bile duct cancer. World journal of gastroenterology: WJG, 13(10), p.1505.

[4] Aggarwal, S., Kaur, R., Kaur, S. and Garg, R. (2015) “Focal Caroli’s Disease Presenting as Fusiform Dilatation of Intrahepatic Biliary Radicles”, Journal of Advances in Medicine and Medical Research, 10(7), pp. 1-6. doi: 10.9734/BJMMR/2015/19776.

[5] Michael, P., Petros, Z., Georgios, K., Stelios, F., Konstantinos, R., Eleni-Aikaterini, N., Christos, T., Sotirios, B., Christos, I. and Constantinos, S. (2013) “Somatostatin Infusions Reduce Post-Operative Bile Leak after Hepatopancreatobiliary Surgery: An Observational Preliminary Study”, Journal of Advances in Medicine and Medical Research, 3(4), pp. 1621-1630. doi: 10.9734/BJMMR/2013/2581.

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