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Zhoubné nádory mimojaterních žlučových cest


Authors: V. Třeška 1;  J. Fichtl 1;  J. Ferda 2;  J. Fínek 3;  T. Skalický 1;  V. Liška 1;  P. Hošek 4
Authors‘ workplace: Chirurgická klinika, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Plzni 1;  Klinika zobrazovacích metod, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Plzni 2;  Onkologická a radioterapeutická klinika, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Plzni 3;  Biomedicínské centrum Lékařské fakulty Univerzity Karlovy v Plzni 4
Published in: Rozhl. Chir., 2022, roč. 101, č. 9, s. 428-435.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2022.101.9.428–435

Overview

Introduction: Biliary tract malignancies belong to very aggressive malignancies of the gastrointestinal tract. The only radical treatment is surgical resection which is possible only in a limited number of cases due to late diagnosis. The aim of this report was to present the experience of our own department with the diagnosis and treatment of these tumours.

Methods: In the years 2005–2021 radical (R0) resection was performed in 27 (28.4%) patients, the same number were managed only symptomatically and in 41 (43.2%) patients we used biliary stenting and external-internal drainage as the definitive procedure. Adjuvant oncological treatment was indicated in 16 (59.3%) of the radically operated and 49 (72.1%) of the non-operated patients.

Results: Median overall survival and median progression-free survival in the operated patients were 19.9 months and 15.7 months, respectively. Overall survival in the operated patients was significantly better (p<0.0001) than in patients managed palliatively. Median overall survival for drainage and palliative treatment was 5.8 and 3.6 months, respectively. Overall survival did not differ between symptomatic and drainage treatment (p<0.3383).

Conclusion: In addition to their histopathological aggressiveness, late diagnosis is the main cause of poor treatment outcomes in extrahepatic biliary tract malignancies. Treatment should be guided by a multidisciplinary team. Currently, there is a great development of endoscopic methods, which, together with further development of personalized oncological treatment, may bring improved results in the future. Surgical, radical treatment remains the method of choice with the best long-term results.

Keywords:

diagnosis – treatment – outcomes – extrahepatic bile duct malignancies


Sources

1. Zamani Z, Fatima S. Biliary tract cancer. StatPearls Publishing 2022.

2. Banales JM, Marin JJG, Lamarca A, et al. Cholangiocarcinoma 2020: The next horizon mechanisms and management. Nat Rev Gastroenterol Hepatol. 2020;17(9):557−588. doi:10.1038/ s41575-020-0310-z.

3. Lee JW, Lee JH, Park Y, et al. Prognostic predictability of American Joint Committee on Cancer 8th staging system for perihilar cholangiocarcinoma: Limited improvement compared with the 7th staging system. Cancer Res Treat. 2020;52(3):886−895. doi: 10.4143/ crt.2020.023.

4. Skalický T, Třeška V, Šnajdauf J, et al. Hepatopankreatobiliární chirurgie. Praha, Maxdorf Jessenius 2011.

5. Lewis HL, Rahnemai-Azar AA, Dillhoff M, et al. Current management of perihilar cholangiocarcinoma and future perspectives. Chirurgia (Bucur) 2017;112(3):193−207. doi:10.21614/ chirurgia.112.3.193.

6. Mansour JC, Aloia TA, Crane ChH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford) 2015;17:691−699. doi:10.1111/hpb.12450.

7. van Keulen AM, Olthof PB, Cescon M, et al. Actual 10-year survival after resection of perihilar cholangiocarcinoma: What factors preclude a chance for cure? Cancers (Basel) 2021;13(24):6260. doi:10.3390/ cancers13246260.

8. Rassam F, Roos E, van Lienden KP, et al. Modern work-up and extended resection in perihilar cholangiocarcinoma: the AMC experience. Langenbecks Arch Surg. 2018;403(3):289−307. doi:10.1007/ s00423-018-1649-2.

9. Mueller M, Breuer E, Mizuno T, et al. Protocol for liver transplantation in hilar cholangiocarcinoma. Arq Bras Cir Dig. 2022;34(3):e1618. doi:10.1590/0102- 672020210002e1618.

10. Cambridge WA, Fairfield C, Powell JJ, et al. Response to the comment on „Meta-analysis and meta-regression of survival after liver transplantation for unresectable perihilar cholangiocarcinoma“. Ann Surg. 2021;274(6):e921−e922. doi:10.1097 / SLA. 0000000000005190.

11. Jingdong L, Yongfu X, Yang G, et al. Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients. Surg Endosc. 2021;35(12):6612−6622. doi:10.1007/ s00464-020-08161-8.

12. Inchingolo R, Acquafredda F, Ferraro V, et al. Non-surgical treatment of hilar cholangiocarcinoma. World J Gastrointest Oncol. 2021;13(11):1696−1708. doi:10.4251/wjgo.v13.i11.1696.

13. Fukasawa M, Takano S, Shindo H, et al. Endoscopic biliary stenting for unresectable malignant hilar obstruction. Clin J Gastroenterol. 2017;10(6):485−490. doi:10.1007/s12328-017-0778-4.

14. Razumilava N, Gores GJ. Building a staircase to precision medicine for biliary tract cancer. Nat Genet. 2015;47(9):967−968. doi:10.1038/ng.3386.

15. Kim JY, Lee S, Kang D, et al. The comparison of endoscopic biliary drainage in malignant hilar obstruction by cholangiocarcinoma: Bilateral metal stents versus multiple plastic stents. Gut Liver 2021;15(6):922−929. doi:10.5009/gnl20257.

16. Lee TH, Moon JH, Park SH. Biliary stenting for hilar malignant biliary obstruction. Dig Endosc. 2020;32(2):275−286. doi:10.1111/den.13549.

17. McNamara MG, Bridgewater J, Palmer DH, et al. A phase Ib study of NUC-1031 in combination with cisplatin for the firstline treatment of patients with advanced biliary tract cancer (ABC-08). Oncologist 2021;26(4):e669−e678. doi: 10.1002/ onco.13598.

18. Lamarca A, Ross P, Wasan HS, et al. Advanced intrahepatic cholangiocarcinoma: Post hoc analysis of the ABC-01, -02, and -03 clinical trials. J Natl Cancer Inst. 2020;112(2):200−210. doi:10.1093/jnci/ djz071.

19. Sota Y, Einama T, Kobayashibayashi K, et al. Recurrent cholangiocarcinoma with long-term survival by multimodal treatment: A case report. Mol Clin Oncol. 2021 Apr;14(4):72. doi:10.3892/mco.2021.2234.

20. Soares KC, Kamel I, Cosgrove DP, et al. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr. 2014;3(1):18−34. doi:10.3978/j.issn.2304-3881.2014.02.05.

21. Modrá kniha České onkologické společnosti, Masarykův onkologický ústav, 2022, ISBN: 978-80-86793-53-5.

22. Makita Ch, Nakamura T, Takada A, et al. Preliminary treatment results of proton beam therapy with chemoradiotherapy for stage I-III esophageal cancer. Cancer Med. 2016;5(3):506−515. doi:10.1002/ cam4.607.

23. Coelen RJS, Vogel JA, Vroomen LG, et al. Ablation with irreversible electroporation in patients with advanced perihilar cholangiocarcinoma (ALPACA): a multicentre phase I/II feasibility study protocol. BMJ Open 2017;7(9):e015810. doi:10.1136/ bmjopen-2016-015810.

24. Chen P, Yang T, Shi P, Shen J, et al. Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: A meta-analysis. Photodiagnosis Photodyn Ther. 2022;37:102712.

25. Andrašina T, Rohan T, Hustý J, et al. Interventional radiology therapies for liver cancer. Cas Lek Cesk. 2018;157(4):195−202.

26. Rohan T, Andrasina T, Matkulcik P. Percutaneous endoluminal radiofrequency ablation of occluded biliary metal stent in malignancy using monopolar technique: A feasibility study. Cardiovasc Intervent Radiol. 2022. doi: 10.1007/s00270-022- 03097-z.

27. Mizandari M, Pai M, Xi F, et al. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol. 2013;36(3):814−819. doi:10.1007/ s00270-012-0529-3.

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