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Surgical criteria for cholangiocarcinoma

Ashley A Weiner, Jeffrey Olsen, Daniel Ma, Pawel Dyk, Todd DeWees, Robert J Myerson, Parag Parikh
BACKGROUND AND PURPOSE: To report outcomes and toxicities of a single-institution phase I/II study of stereotactic body radiotherapy (SBRT) in the treatment of unresectable hepatocellular cancer (HCC) and intrahepatic cholangiocarcinoma (IHC). MATERIALS AND METHODS: Patients with Child-Pugh score less than 8 were eligible. A total of 32 lesions in 26 patients were treated with SBRT. Kaplan-Meier survival analysis was performed. Toxicities were graded by CTCAEv4 criteria and response was scored by EASL guidelines...
August 23, 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Siham Ait Oussous, Saïd Boujraf, Imane Kamaoui
The goal is assessing the diffusion magnetic resonance imaging (dMRI) method efficiency in characterizing focal hepatic lesions (FHLs). About 28-FHL patients were studied in Radiology and Clinical Imaging Department of our University Hospital using 1.5 Tesla MRI system between January 2010 and June 2011. Patients underwent hepatic MRI consisting of dynamic T1- and T2-weighted imaging. The dMRI was performed with b-values of 200 s/mm(2) and 600 s/mm(2). About 42 lesions measuring more than 1 cm were studied including the variation of the signal according to the b-value and the apparent diffusion coefficient (ADC)...
April 2016: Journal of Medical Signals and Sensors
Saori Onda, Takeshi Ogura, Yoshitaka Kurisu, Daisuke Masuda, Tatsushi Sano, Wataru Takagi, Shinya Fukunishi, Kazuhide Higuchi
BACKGROUND: Few reports have described endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for biliary lesions. In addition, adverse events were not completely examined in previous reports, due to the inclusion of cases in which biliary stents had already been placed. The present study aimed to investigate the diagnostic yield and adverse events of EUS-FNA for biliary lesions as the first-line diagnostic modality for consecutive prospectively registered patients. METHODS: Inclusion criteria were as follows: (1) patients with suspected cholangiocarcinoma (CCA) based on computed tomography or other imaging modalities; (2) patients who had not previously undergone endoscopic retrograde cholangiopancreatography or EUS-FNA; (3) absence of surgically altered anatomy, such as Roux-en-Y anastomosis or duodenal obstruction caused by tumor invasion, through which an endoscope could not pass; and (4) provision of written informed consent to all procedures associated with the study...
May 2016: Therapeutic Advances in Gastroenterology
Taizo Hibi, Osamu Itano, Masahiro Shinoda, Yuko Kitagawa
The indications of liver transplantation for hepatobiliary malignancies have been carefully expanded in a stepwise fashion, despite the fundamental limitations in oncological, immunological, and technical aspects. A new era of "Transplant Oncology," the fusion of transplant surgery and surgical oncology, has begun, and we stand at the dawn of a paradigm shift in multidisciplinary cancer treatment. For hepatocellular carcinoma, new strategies have been undertaken to select recipients based on biological and dynamic markers instead of conventional morphological and static parameters, opening the doors for a more deliberate expansion of the Milan criteria and locoregional therapies before liver transplantation...
April 29, 2016: Surgery Today
Cyriel Y Ponsioen
According to recent guidelines, primary sclerosing cholangitis (PSC) is diagnosed when a patient has a cholestatic liver enzyme profile, characteristic bile duct changes on imaging, and when secondary causes of sclerosing cholangitis are excluded. In patients with a clinical suspicion but normal cholangiography, a liver biopsy is indicated to establish a diagnosis of small duct PSC. Several other disease entities such as IgG4-associated cholangitis (IAC), cholangiocarcinoma (CCA), and secondary causes of sclerosing cholangitis such as choledocholithiasis, AIDS-cholangiopathy, ischemia, surgical bile duct trauma, or mast cell cholangiopathy can mimic PSC...
2015: Digestive Diseases
Gaya Spolverato, Yuhree Kim, Sorin Alexandrescu, Hugo P Marques, Jorge Lamelas, Luca Aldrighetti, T Clark Gamblin, Shishir K Maithel, Carlo Pulitano, Todd W Bauer, Feng Shen, George A Poultsides, Thuy B Tran, J Wallis Marsh, Timothy M Pawlik
BACKGROUND: Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma (ICC) following curative-intent surgery are not well documented. We sought to characterize the treatment of patients with recurrent ICC and define therapy-specific outcomes. METHODS: Patients who underwent surgery for ICC from 1990 to 2013 were identified from an international database. Data on clinicopathological characteristics, operative details, recurrence, and recurrence-related management were recorded and analyzed...
January 2016: Annals of Surgical Oncology
Koji Hashimoto, Charles M Miller
The indication of liver transplantation for intrahepatic cholangiocarcinoma (ICC) is highly controversial. Initially, liver transplantation was embraced as a promising treatment for ICC, providing both a wider surgical margin and a potential cure for the underlying liver disease. However, the majority of transplant centers have abandoned liver transplantation for ICC due to poor long-term survival and high recurrence rates. Interestingly, these decisions were based on studies with highly inconsistent outcomes due to a limited number of patients, various patient selection criteria, and the use of nonstandardized adjunctive therapy protocols...
February 2015: Journal of Hepato-biliary-pancreatic Sciences
Matteo Ravaioli, Giorgio Ercolani, Flavia Neri, Matteo Cescon, Giacomo Stacchini, Massimo Del Gaudio, Alessandro Cucchetti, Antonio Daniele Pinna
Improvements in the medical and pharmacological management of liver transplantation (LT) recipients have led to a better long-term outcome and extension of the indications for this procedure. Liver tumors are relevant to LT; however, the use of LT to treat malignancies remains a debated issue because the high risk of recurrence. In this review we considered LT for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), liver metastases (LM) and other rare tumors. We reviewed the literature, focusing on the past 10 years...
May 14, 2014: World Journal of Gastroenterology: WJG
Omar Hyder, Hugo Marques, Carlo Pulitano, J Wallis Marsh, Sorin Alexandrescu, Todd W Bauer, T Clark Gamblin, Georgios C Sotiropoulos, Andreas Paul, Eduardo Barroso, Bryan M Clary, Luca Aldrighetti, Cristina R Ferrone, Andrew X Zhu, Irinel Popescu, Jean-Francois Gigot, Gilles Mentha, Shen Feng, Timothy M Pawlik
IMPORTANCE: Intrahepatic cholangiocarcinoma (ICC) is a primary cancer of the liver that is increasing in incidence, and the prognostic factors associated with outcome after surgery remain poorly defined. OBJECTIVE: To combine clinicopathologic variables associated with overall survival after resection of ICC into a prediction nomogram. DESIGN, SETTING, AND PARTICIPANTS: We performed an international multicenter study of 514 patients who underwent resection for ICC at 13 major hepatobiliary centers in the United States, Europe, and Asia from May 1, 1990, through December 31, 2011...
May 2014: JAMA Surgery
X-R Yu, W-Y Huang, B-Y Zhang, H-Q Li, D-Y Geng
AIM: To retrospectively evaluate the criteria for discriminating infiltrative cholangiocarcinoma from benign common bile duct (CBD) stricture using three-dimensional dynamic contrast-enhanced (3D-DCE) magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography (MRCP) imaging and to determine the predictors for cholangiocarcinoma versus benign CBD stricture. MATERIALS AND METHODS: 3D-DCE MRI and MRCP images in 28 patients with infiltrative cholangiocarcinoma and 23 patients with benign causes of CBD stricture were reviewed retrospectively...
June 2014: Clinical Radiology
Jue-lei Wang, Yun-sheng Yang, Hao Liang, Qi-yang Huang, Feng-chun Cai, Yan Dou, Guo-jun Chai, Qing-sen Liu
OBJECTIVE: To discuss the difference in diagnostic criteria of autoimmune pancreatitis(AIP) and its major influential factors, so as to provide guidance for AIP diagnosis and treatment. METHODS: The clinical data of 561 cases of chronic pancreatitis admitted to PLA General Hospital from June, 2008 to January, 2013 were retrospectively reviewed and analyzed. Data were extracted and analyzed to summarize the reasons of the differences in AIP diagnosis rate diagnosed by different diagnostic criteria...
June 2013: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Jan Grendar, Petra Grendarova, Richie Sinha, Elijah Dixon
BACKGROUND: Hilar cholangiocarcinoma is a rare but highly lethal type of cancer. A minority of patients present with resectable disease. Surgery remains the only treatment modality offering a chance of long-term survival. Unresectable patients are typically offered palliative treatment. The aim of this systematic review was to summarize the evidence for neoadjuvant therapy followed by surgical resection in patients presenting with hilar cholangiocarcinoma. METHODS: Cochrane databases, Medline, PubMed and EMBASE were systematically searched to identify articles describing neoadjuvant therapy and surgical resection or re-assessment of resectability in patients with hilar cholangiocarcinoma...
April 2014: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Tiffany C L Wong, Ronnie T P Poon
With the higher incidences of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) in the East compared with the West, Asian centers have made significant contributions to the management of these malignancies. The major risk factor for HCC is hepatitis B infection in Asia in contrast to hepatitis C in Western populations. Barcelona Clinic for Liver Cancer (BCLC) staging that guides the treatment of patients with HCC in the West is considered too conservative by many Asian centers. In Asia, liver resection is widely offered to patients with multifocal, bilobar tumor or tumor invasion to the portal vein...
2013: Digestive Diseases
Gregory J Gores, Sarwa Darwish Murad, Julie K Heimbach, Charles B Rosen
Perihilar cholangiocarcinoma is a complex and devastating disease. Its complexity in part arises from the difficulty of establishing a diagnosis, especially in primary sclerosing cholangitis (PSC) patients. We have found fluorescent in situ hybridization (FISH) of cytologic specimens to be helpful in establishing a diagnosis of cholangiocarcinoma. In particular, FISH polysomy is useful in establishing a diagnosis of this malignancy. Endoscopic ultrasound with fine needle aspirates of regional lymph nodes has high utility in identifying patients who have advanced disease with lymph node metastases...
2013: Digestive Diseases
Juan-Ramón Ayuso, Mario Pagés, Anna Darnell
Cholangiocarcinoma (CC) is the most frequent neoplasm of the biliary system. According to its anatomic origin in the biliary tree it is usually classified as intrahepatic, perihilar, or extrahepatic distal CC. Tumors originated in these areas differ in biological behavior and management. The stratification of the patients aligned to therapeutic options and prognosis is a key point in the management of CC. Thus, specific staging systems have been designed for each anatomical location. They are precise for surgical planning, to establish prognosis after surgery, or to compare the benefits of different therapeutic approaches, but they are less accurate to stratify patients into a therapeutic decision algorithm...
October 2013: Abdominal Imaging
Siripong Sirikurnpiboon, Burin Awapittaya, Jerasak Wannaprasert
BACKGROUND: An in-patient presented with atypical primary liver mass and was suspected of having liver metastasis. One method of investigation is colonoscopy; however, there are currently no clear guidelines to indicate when this procedure should be performed. MATERIAL AND METHOD: This was a retrospective review of 6 years' data from the surgical endoscopic unit in Rajavithi Hospital. The inclusion criteria were: (1) patient presented with liver mass, (2) radiological findings (mainly from CT scan or MRI) were not typicalfor hepatocellular carcinoma (HCC), intrahepatic cholagiocarcinoma (ICGC) and other primary liver tumors...
March 2013: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
L Viganò, A Ferrero, M Amisano, N Russolillo, L Capussotti
BACKGROUND: Laparoscopic liver surgery must reproduce open surgical steps. Intraoperative ultrasonography (IOUS) is mandatory, but reliability of laparoscopic IOUS has been poorly evaluated. The aim of this study was to compare laparoscopic versus open IOUS in staging liver tumours. METHODS: All patients scheduled for liver resection between September 2009 and March 2011 were considered. Inclusion criteria were primary and metastatic tumours. Exclusion criteria were: hilar/gallbladder cholangiocarcinoma, ten or more lesions, repeat resection, laparoscopic hepatectomy, adhesions and unresectability...
March 2013: British Journal of Surgery
Hiroshi Kawashima, Yutaka Takeda, Shin Nakahira, Yosuke Mukai, Michiko Hamanaka, Chieko Uchiyama, Takeshi Kanemura, Masatsugu Okishiro, Atsushi Takeno, Rei Suzuki, Hirokazu Taniguchi, Ken Nakata, Chiyomi Egawa, Hirofumi Miki, Takeshi Kato, Shigeyuki Tamura
A 57-year-old woman who was diagnosed with cholangiolocellular carcinoma underwent neoadjuvant chemotherapy with gemcitabine (GEM). The clinical stage was cT3N1M1 (right adrenal grand),cStage IVB (JPS) with invasion to the inferior vena cava (IVC). We were willing to perform hepatectomy if the response to chemotherapy was stable disease (SD) or better according to the Response Evaluation Criteria In Solid Tumors. After 2 courses of preoperative chemotherapy with GEM, SD was obtained. She underwent right lobectomy of the caudate lobe and resection of the right adrenal gland...
November 2012: Gan to Kagaku Ryoho. Cancer & Chemotherapy
M Nguyen-tat, T Gamstätter, J U Marquardt, E Geißinger, S Schadmand-Fischer, H Lang, E Siegel, M Schuchmann, P R Galle, M A Wörns
IgG4-related disease has gained increased attention worldwide. While the initial focus was on autoimmune pancreatitis which was first described in Asian populations and turned out to be of relevance in Western populations too, the scope has recently broadened towards a notion of a multi-systemic disease with very diverse manifestations such as autoimmune pancreatitis, IgG4-related sclerosing cholangitis (IgG4-SC), retroperitoneal fibrosis and tubulointerstitial nephritis. IgG4-SC (also known as IgG4-associated cholangitis, IAC) represents a rare but clinically challenging differential diagnosis in patients with obstructive jaundice and proximal extra- or intrahepatic biliary strictures which can be mistaken for cholangiocarcinoma (CC)...
September 2012: Zeitschrift Für Gastroenterologie
Dhakshinamoorthy Ganeshan, Fanny E Moron, Janio Szklaruk
Tumor staging defines the point in the natural history of the malignancy when the diagnosis is made. The most common staging system for cancer is the tumor, node, metastases classification. Staging of cancers provides useful parameters in the determination of the extent of disease and prognosis. Cholangiocarcinoma are rare and refers to cancers that arise from the biliary epithelium. These tumors can occur anywhere along the biliary tree. These tumors have been previously divided into extrahepatic and intrahepatic lesions...
August 28, 2012: World Journal of Radiology
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