Excerpt from the 2022 American Association for the Study of Liver Diseases clinical practice guideline: management of primary sclerosing cholangitis and cholangiocarcinoma / 中华肝脏病杂志

What are the new contents of the guideline since 2010?A.Patients with primary and non-primary sclerosing cholangitis (PSC) are included in these guidelines for the diagnosis and management of cholangiocarcinoma.B.Define "related stricture" as any biliary or hepatic duct stricture accompanied by the signs or symptoms of obstructive cholestasis and/or bacterial cholangitis.C.Patients who have had an inconclusive report from MRI and cholangiopancreatography should be reexamined by high-quality MRI/cholangiopancreatography for diagnostic purposes. Endoscopic retrograde cholangiopancreatography should be avoided for the diagnosis of PSC.D. Patients with PSC and unknown inflammatory bowel disease (IBD) should undergo diagnostic colonoscopic histological sampling, with follow-up examination every five years until IBD is detected.E. PSC patients with IBD should begin colon cancer monitoring at 15 years of age.F. Individual incidence rates should be interpreted with caution when using the new clinical risk tool for PSC for risk stratification.G. All patients with PSC should be considered for clinical trials; however, if ursodeoxycholic acid (13-23 mg/kg/day) is well tolerated and after 12 months of treatment, alkaline phosphatase (γ- Glutamyltransferase in children) and/or symptoms are significantly improved, it can be considered to continue to be used.H. Endoscopic retrograde cholangiopancreatography with cholangiocytology brushing and fluorescence in situ hybridization analysis should be performed on all patients suspected of having hilar or distal cholangiocarcinoma.I.Patients with PSC and recurrent cholangitis are now included in the new unified network organ sharing policy for the end-stage liver disease model standard.J. Liver transplantation is recommended after neoadjuvant therapy for patients with unresectable hilar cholangiocarcinoma with diameter < 3 cm or combined with PSC and no intrahepatic (extrahepatic) metastases.

Transarterial radioembolization for liver tumors as neoadjuvant therapy: three case reports / Radioembolização transarterial hepática como terapia neoadjuvante: relato de três casos

ABSTRACT Transarterial radioembolization (TARE) with yttrium-90 microspheres is a palliative locoregional treatment, minimally invasive for liver tumors. The neoadjuvant aim of this treatment is still controversial, however, selected cases with lesions initially considered unresectable have been enframed as candidates for curative therapy after hepatic transarterial radioembolization. We report three cases in which the hepatic transarterial radioembolization was used as neoadjuvant therapy in an effective way, allowing posterior potentially curative therapies.

RESUMO A radioembolização transarterial hepática com microesferas de ítrio-90 é uma modalidade paliativa de tratamento locorregional minimamente invasiva. O objetivo neoadjuvante deste tratamento ainda é controverso, mas casos selecionados de lesões consideradas inicialmente irressecáveis reenquadram-se como candidatos à terapia curativa após a radioembolização transarterial hepática. Relatamos três casos em que a radioembolização transarterial hepática foi utilizada como terapia neoadjuvante de forma efetiva possibilitando aplicação posterior de terapias potencialmente curativas.

Intrahepatic, Perihilar and Distal Cholangiocarcinoma: Management and Outcomes

Abstract: Introduction and aims. Cholangiocarcinomas are a heterogeneous group of tumors that can be classified into three clinically distinct types of cancers, intrahepatic, perihilar and distal cholangiocarcinoma. The inconsistent use of nomenclature for these cancers has obscured a true knowledge of the epidemiology, natural history and response to therapy of these cancers. Our aims were to define demographic characteristics, management and outcomes of these three distinct cancer types. Materials and methods. A retrospective study of patients enrolled in an institutional cancer registry from 1992 to 2010. Median survival was compared between different treatment modalities over three time periods for the three types of cholangiocarcinoma at different stages of the disease using Kaplan Meyer analysis. Results. 242 patients were identified. All cases were reviewed and classified into intrahepatic (90 patients), distal (48 patients) or perihilar (104 patients) cholangiocarcinomas. These cancers differed in median age of onset, gender distribution, median survival and stage. 13.8% of patients presented with stage I, 5.8% with stage II, 9.6% with stage III, 28% with stage IV, with 41.8% having unknown stage. The overall median survival was 15.8 months, and was 23, 25, 14, and 4.5 months for stages I, II, III, and IV respectively. Surgery improved survival in both early and advanced stages. Multimodality therapies further improved outcomes, particularly for perihilar cholangiocarcinoma. Conclusion. Perihilar, distal and intrahepatic cholangiocarcinoma vary in their presentation, natural history and therapeutic approach to management. A consistently applied classification is essential for meaningful interpretation of studies of these cancers.

Guideline for the management of bile duct cancers by the brazilian gastrointestinal tumor group

ABSTRACT The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.

RESUMO O Grupo Brasileiro de Tumores Gastrointestinais desenvolveu diretrizes de tratamento cirúrgico e clínico de pacientes com tumores de vias biliares. O painel multidisciplinar foi composto de especialistas nas áreas radiologia, oncologia, cirurgia, radioterapia, endoscopia e anatomia patológica. O painel utilizou literatura atual para desenvolver recomendações baseadas em evidência científica para as diferentes estratégias terapêuticas e diagnósticas dos colangiocarcinomas e tumores de vesícula biliar.

Colangiocarcinoma en el 2011 / Cholangiocarcinoma in 2011

Cholangiocarcinoma is a rare disease in the western World, but it comprises a diagnostic and therapeutic challenge. Its outcome strongly depends on early diagnosis and complete surgical resection. As of today there are no surgical procedures that have proved increase in the survival rate for patients with these types of tumors. Recently, liver transplant appears as a promising alternative reporting a survival rate over 80 percent in 5 years. However, it has been impossible to replicate these results in the majority of the Centers specialized in the management of this disease. The present article shows epidemiological data of the disease, diagnostic methods and options of treatment according to the staging.

El colangiocarcinoma es una patología infrecuente en el mundo occidental, pero representa un desafío diagnóstico y terapéutico. Su pronóstico es muy dependiente de la precocidad del diagnóstico y la resección quirúrgica completa. Hasta ahora no existen terapias no quirúrgicas que hayan demostrado aumentar la sobrevida para este tipo de tumores. Últimamente, el trasplante de hígado aparece como una alternativa promisoria con reportes de sobrevida por sobre el 80 por ciento a 5 años, sin embargo, estos resultados no han podido ser replicados por la mayoría de los centros con alta experiencia en el manejo de esta enfermedad. En el presente artículo se detallan los antecedentes epidemiológicos de la enfermedad, los métodos diagnósticos y opciones de tratamiento según el estadío.

Lobectomia hepática direita com ressecção dos portais laparoscópicos para o tratamento do carcinoma de vesícula biliar incidental / Right hepatic lobectomy with laparoscopic portal excision for incidental gallbladder carcinoma

Introdução. A despeito de sua raridade, o carcinoma da vesícula biliar tem comportamento agressivo e péssimo prognóstico. Contudo, a ressecção hepática (segmentectomia IV-V ou lobectomia direita) associada à linfadenectomia hilar é a única abordagem terapêutica curativa nos tumores T2 e T3. Quando o diagnóstico de câncer é incidental, após colecistectomia laparoscópica, é recomendada adicionalmente a ressecção dos portais laparoscópicos. Relato do caso. Os autores relatam um caso de adenocarcinoma de vesícula biliar T2 (TNM) cujo diagnóstico foi incidental por colecistectomia laparoscópica. Subsequentemente foi submetida à lobectomia hepática direita com linfadenectomia hilar e ressecção dos portais com boa evolução. Atualmente, dois anos após a operação a doente apresenta-se bem sem sinais de recidiva. Conclusão. O tratamento cirúrgico radical com hepatectomia e linfadenectomia hilar com ressecção dos portais laparoscópicos no carcinoma vesicular biliar incidental (colecistectomia laparoscópica) podem levar a um controle da doença em longo prazo.

Introduction. Despite its rarity, gallbladder carcinoma with agressive behavior and dismal prognosis. However, hepatic resection (IV-V segmentectomy or right lobectomy) and hilar linfadenectomy is a single curative approach for T2-T3 tumors. Nevertheless, when cancer diagnosis is incidental (after laparoscopic cholecistectomy) portal laparoscopic resection has been additionally advised. Case report. Authors present a case of T2 gallbladder adenocarcinoma whose diagnosis was incidental (laparoscopic cholecistectomy). Consequently, right hepatic lobectomy with hilar linfadenectomy and portal resection was done. Patient presented with good postoperative course. At the present moment, two years after surgical procedure done, the patient is doing well without tumor recurrence. Conclusion. Radical surgical treatment of incidental gallbladder carcinoma (laparoscopic cholecistectomy) withhepatectomy plus hilar linfadenectomy and portal resection may offer a long-term disease control.

Colangiocarcinoma: Actualización, diagnóstico y terapia: [revisón] / Cholangiocarcinoma: [review]

Cholangiocarcinoma is a malignant lesion of the bile duct epithelium. Its incidence and prevalence are low. It appears from the sixth decade of life and there is slight male predominance. It is most frequently found in the confluence of the hepatic ducts, where it is called hilar cholangiocarcinoma or Klatskin tumor. Its etiology is unknown but there are predisposing conditions and environmental risk factors such as primary sclerosing cholangitis, Caroli's disease, bile duct malformations, industrial toxins and parasitic infections. The classic presentation of cholangiocarcinoma includes jaundice, weight loss and right upper quadrant pain. These, in addition to laboratory exams, endoscopical and imaging procedures, lead to the diagnosis. Hilar cholangiocarcinoma must be distinguished from other malignant or benign causes of biliary obstruction. Cholangiocarcinoma of the distal common bile duct must be differentiated from other periampullary tumors and intrahepatic cholangiocarcinoma can be confused with a hepatocellular carcinoma. Two classifications are used for clinical staging: TNM and Bismuth-Corlette. The best treatment is the complete surgical excision with negative histological margins, although the resectability index is low. The type and size of surgery depends on the location and extent of the tumor. Patients with unresectable tumors can be subjected to palliative procedures such as biliary-enteric bypass, endoscopic or pecutaneous stent placement. Chemotherapy is not effective. Recently, endoscopic phototherapy has emerged as a better alternative for palliative care.

Modified single step ultrasound guided percutaneous transhepatic biliary drainage (MSSUGPTBD): experience with 102 patients.

Modified single step ultrasound guided percutaneous transheptic biliary drainage was performed in 102 patients between 1993 and 1998 at the National Cancer Institute, Bangkok with successfully placed drainage tubes in the dilated bile ducts. The advantages of this technique are single step puncture without major complication or bleeding, reduction of radiation exposure, capability for bile duct selection and time saving.

Villous adenoma of the bile ducts: a case report and a review of the reported cases in Korea

Villous adenomas are benign epithelial lesions with malignant potential which can occur at any site in the gastrointestinal tract. They are usually encountered in the rectum and colon, less frequently in the small bowel and very rarely in the biliary trees. Nine cases of bile duct villous adenomas have been reported in the literature. However, 4 cases of bile duct villous adenomas have been reported in the Korean literature. Recently, we experienced a case of villous adenoma in the common hepatic duct in a 77-year-old man presenting with obstructive jaundice in which preoperative histologic diagnosis of villous adenoma played a critical role in managing this patient. Herein, we present a case report of bile duct villous adenoma and a review of the reported cases in Korea to help define and manage this rare disease entity in the bile ducts. In addition, confusing nomenclature of bile duct adenomas is discussed.

Hepatocolecistojejunostomia em y de Roux no tratamento paliativo da icterícia por tumor inoperável ao nível do pedículo bibliar / Y in Roux hepatocholecystojejunostomy in the palliative treatment of jaundice due to biliary unresectable tumor

Uma hepatocolecistojejunostomia em Y de Roux foi realizada para descomprimir a árvore biliar obstruída por metástase de adenocarcinoma gástrico inoperável. A paciente teve recuperaçäo pós-operatória sem complicaçöes, com melhorra da icterícia e dos níveis séricos de bilirrubinas