Distal Common Bile Duct Cancer Research Articles

Pulmonary Cryptococcosis Mimicking Metastasis in a Distal Common Bile Duct Cancer Patient after Recent COVID-19 Infection

The only curative treatment option for cholangiocarcinoma is surgery, making the assessment of operability a crucial step in the diagnosis. We report a case of distal common bile duct cancer in a 64-year-old male, who exhibited multiple pulmonary nodules in pre-operative chest imaging following a COVID-19 infection. As the local progression of disease was not prominent, the possibility of pulmonary metastasis was considered unlikely. A surgical biopsy was performed, which confirmed the diagnosis of pulmonary cryptococcosis.

Germline Pathogenic Variants in Patients With Pancreatic and Periampullary Cancers.

Inherited cancer susceptibility is often not suspected in the absence of a significant cancer family history. Pathogenic germline variants in pancreatic cancer are well-studied, and routine genetic testing is recommended in the guidelines. However, data on rare periampullary cancers other than pancreatic cancer are insufficient. We compared the prevalence of germline susceptibility variants in patients with pancreatic cancer and nonpancreatic periampullary cancers. Six hundred and eight patients who had undergone pancreaticoduodenal resection at a tertiary referral hospital were studied, including 213 with pancreatic ductal adenocarcinoma, 172 with ampullary cancer, 154 with distal common bile duct cancer, and 69 with duodenal adenocarcinoma. Twenty cancer susceptibility and candidate susceptibility genes were sequenced, and variant interpretation was assessed by interrogating ClinVar and PubMed. Pathogenic or likely pathogenic, moderate- to high-penetrant germline variants were identified in 46 patients (7.7%), including a similar percentage of patients with pancreatic (8.5%) and nonpancreatic periampullary cancer (7.1%). Low-penetrant variants were identified in an additional 11 patients (1.8%). Eighty-nine percent of the moderate- to high-penetrant variants involved the major cancer susceptibility genes BRCA2, ATM, BRCA1, CDKN2A, MSH2/MLH1, and PALB2; the remaining 11% involved other cancer susceptibility genes such as BRIP1, BAP1, and MSH6. Almost all pathogenic variant carriers had a family history of cancer. Patients with pancreatic and nonpancreatic periampullary cancer have a similar prevalence of pathogenic cancer susceptibility variants. Germline susceptibility testing should be considered for patients with any periampullary cancer.

Cell-free DNA as a prognostic and predictive biomarker in resectable distal common bile duct cancer.

Cell-free DNA (cfDNA) as an oncological biomarker has drawn much attention in recent years, but very limited effort has been made to investigate the prognostic values of cfDNA in distal common bile duct (CBD) cancer. Plasma cfDNA was measured in 67 patients with resectable distal CBD cancer. Survival outcomes and the correlation of cfDNA with other conventional prognostic factors were determined. cfDNA levels were significantly higher in female patients, and those with poor tumor differentiation, abnormal serum carcinoembryonic antigen (CEA) level, and stage III cancer. The significant prognostic factors included a high cfDNA level (>8955 copies/mL), abnormal serum CEA level, stage III cancer, and positive resection margins. Compared with patients with high cfDNA level, those with lower cfDNA level (≤8955 copies/mL) had significantly better overall survival outcomes (74.4% vs 100% and 19.2% vs 52.6%, for 1- and 5-year survival rates, respectively, p = 0.001). The cfDNA level, perineural invasion, CEA level, and radicality were identified as independent prognostic factors for distal CBD cancer after multivariate analysis. Circulating cfDNA levels play a significant role in predicting the prognosis and survival outcome for resectable distal CBD cancer. Furthermore, acting as a promising liquid biopsy, cfDNA could serve as a prognostic and predictive biomarker in combination with current conventional markers to improve diagnostic and prognostic efficacy.

Synchronous Primary Adenocarcinoma of Distal Common Bile Duct and Gall bladder.

Synchronous primary cancer of the gall bladder and distal common bile duct is rare. There are only few case reports and case series available of these synchronous cancers. Management of this tumor is individualized in these case reports and series based upon the presentation. We present a case of a patient who had multifocal adenocarcinoma involving distal common bile duct and gall bladder. Keywords: Distal common bile duct cancer; gall bladder cancer; synchronous primary.

The first case of cholecytitis caused by Aggregatibacter kilianii in Korea

BackgroundThe bacterial genus Aggregatibacter was categorized in 2006 to accommodate the former Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and H. segnis species. Aggregatibacter kilianii is a normal resident of the human upper respiratory tract but can also cause serious infections. A. kilianii is relatively newly identified and has been isolated from conjunctivitis, wounds, abdominal abscesses, and blood.Case presentationAn 80-year-old female patient with distal common bile duct cancer was admitted to our hospital with sudden loss of consciousness and general weakness, fever, and abdominal pain for 3 days. Two colonial morphologies were isolated from both the blood and bile cultures; one was identified as Streptococcus constellatus subsp. pharyngis, but the other was not recognized by Vitek2 and MALDI-TOF. The 16 S rRNA sequences showed 99.73% similarity with the sequence of A. kilianii strains.Conclusion and discussionThis article presents the first case of a clinical isolate of A.kilianii outside Europe. This case is also the first of the antimicrobial profile of this strain. This report highlights the importance of proper molecular identification for timely diagnosis and treatment of disease.

Factors influencing patterns of recurrence following pancreaticoduodenectomy for patients with distal bile duct cancer and ampulla of Vater cancer.

Backgrounds/AimsPancreaticoduodenectomy (PD) is a standard surgical procedure for patients with periampullary cancer. During the follow-up period after PD, recurrence can be observed in various places with different prognosis. The aim of this study was to clarify the pattern of recurrence and factors affecting the survival of patients with periampullary cancer.MethodsOverall, 88 patients who received PD for distal common bile duct cancer or ampulla of Vater cancer were finally included and their clinical characteristics were analyzed. Patients were divided into three groups: recurrence-free (RF) group, an isolated locoregional recurrence (LR) group, and a distant metastasis (DM) group. Prognostic factors affecting recurrence in each group were analyzed and a survival analysis was performed.ResultsPerineural invasion (PNI), T stage, and lymphovascular invasion (LVI) were significant risk factors for LR and PNI, lymph node metastasis, LVI, and T stage were associated with DM group compared to RF group in univariate analysis, respectively. N stage and PNI were significant risk factors (p = 0.046, p = 0.041) in overall survival of the LR and the DM groups. There was no significant difference in 5-year overall survival between the LR and DM groups.ConclusionsT stage was a significant risk factor of LR, while PNI was a significant risk factor of DM. There was no significant difference in overall survival depending on the site of recurrence.

Surgical Outcomes and Prognostic Factors of Distal Common Bile Duct Adenocarcinoma: Chronological Comparison in a Single Institutional Experience of a Tertiary Cancer Center

Introduction: Distal common bile duct (dCBD) cancer is main indication of pancreaticoduodenectomy (PD). Purpose of our study was to evaluate surgical outcomes of dCBD adenocarcinoma that PD was performed in single institute. And we aimed to investigate prognostic factors of dCBD cancer.

Conversion surgery for initially unresectable extrahepatic biliary tract cancer.

Backgrounds/AimsSurgical resection is the only curative treatment for biliary tract cancers; however, most patients undergo palliative chemotherapy because they are contraindicated for surgery. Conversion surgery, a treatment strategy for downsizing chemotherapy and subsequent surgical resection, is feasible for initially unresectable biliary tract cancers following the introduction of effective chemotherapeutic agents.MethodsPatients initially diagnosed with unresectable biliary tract cancers, and treated with conversion surgery after palliative chemotherapy between 2013 and 2019, were reviewed retrospectively.ResultsTwelve patients underwent conversion surgery after palliative chemotherapy for initially unresectable biliary tract cancers. The final pathological diagnosis included six perihilar cholangiocarcinomas, four distal common bile duct cancers, and two gallbladder cancers. Different chemotherapy regimens were used, but all the patients were treated with gemcitabine at some point during their treatment. The median overall survival was 28 months, which was longer than that of patients treated with isolated palliative chemotherapy in previous studies.ConclusionsConversion surgery represents a therapeutic alternative for specific cases of unresectable biliary tract cancers. Palliative chemotherapy for initially unresectable biliary tract cancers is recommended for downsizing the tumor and expanding the indications for surgery. Further studies and clinical trials are required to develop new and effective chemotherapeutic regimens.

Bile Microbiota in Patients with Pigment Common Bile Duct Stones

BackgroundCommon bile duct (CBD) stone is one of the most prevalent gastroenterological diseases, but the role played by biliary microbiota in the pathogenesis of CBD stones remains obscure. The aim of this study was to investigate the characteristics of the biliary tract core microbiome and its potential association with the formation of pigment stones.MethodsTwenty-eight patients with biliary obstruction of various causes were enrolled. Thirteen had new-onset pigment CBD stone. Of the remaining 15, four had benign biliary stricture, four had gallbladder cancer, three had pancreatic cancer, 3 had distal CBD cancer, and one had hepatocellular carcinoma. Endoscopic retrograde cholangiopancreatography was used to collect bile samples for DNA extraction, 16S ribosomal RNA gene sequencing, and bile microbiota composition analysis.ResultsProteobacteria (61.7%), Firmicutes (25.1%), Bacteroidetes (5%), Fusobacteria (4.6%), and Actinobacteria (2.6%) were the most dominant phyla in the bile of the 28 study subjects. A comparison between new-onset choledocholithiasis and other causes of biliary obstruction (controls) showed Enterococcus was found to be significantly abundant in the CBD stone group at the genus level (linear discriminant analysis score = 4.38; P = 0.03). However, no other significant compositional difference was observed.ConclusionThis study demonstrates an abundance of microbiota in bile juice and presents a biliary microbiome composition similar to that of duodenum. The study also shows Enterococcus was significantly abundant in the bile juice of patients with a brown pigment stone than in controls, which suggests Enterococcus may play an important role in the development of pigment stones.

Low H3K9me3 Expression Is Associated With Poor Prognosis in Patients With Distal Common Bile Duct Cancer.

Histone modification is associated with tumorigenesis and cancer progression. Recent studies have revealed the prognostic value of histone modification; however, its prognostic role in distal bile duct cancer remains unclear. We analyzed the expression of H3K9me3, H4K20me3, and H3K36me3 and its correlation with survival outcomes in resected samples from 88 patients with distal bile duct cancer. Low expression rates of H3K9me3, H4K20me3, and H3K36me3 were significantly associated with poor overall survival (p=0.003, 0.008, and 0.047, respectively) and event-free survival (p=0.03 for H3K9m3). Additionally, low-expression of H3K9me3 was an independent poor prognostic indicator (p<0.001; HR=7.85; 95% CI=2.693-22.883). H3K9me3 was an independent poor prognostic factor in distal common bile duct cancer. Our results suggest that histone markers are potential prognostic markers and provide better management for patients at risk for an aggressive course of disease.

Coordination and function of a laparoscopic assistant in laparoscopic pancreaticoduodenectomy

Objective To study the coordination and function of a laparoscopic assistant in laparoscopic pancreaticoduodenectomy (LPD). Methods A retrospective analysis was conducted on 101 patients who underwent LPD at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, from January 2014 to March 2017. The study aimed to study the coordination and function of a laparoscopic assistant. Results LPD was successfully completed in all the 101 patients. There was no conversion to open surgery. The operation time was (326.0±55.6) min, and the resection time was (174.4±42.5) min. The digestive tract reconstruction time was(101.0±21.4) min. The time of pancreaticojejunostomy was (40.5±8.7) min. The time of gastrointestinal anastomosis was: (26.3±5.5) min. The time of biliary anastomosis was (24.4±6.5) min. The intraoperative bleeding was (175.6±41.1) ml. Postoperative pathological data showed that 27 patients (26.7%) had distal common bile duct cancer, 23 patients (22.8%) ampullary carcinoma, 39 patients (38.6%) duodenal papillary carcinoma, and 12 patients (11.9%) pancreatic ductal adenocarcinoma. The tumor diameter was (2.3±1.3) cm, and the number of resected lymph nodes was (16.7±4.2). The number of positive lymph nodes was 1.3±1.1. The length of postoperative hospital stay was 14.8 (8~29) d. Twenty-three patients developed postoperative pancreatic fistula, including 17 patients (16.8%) with a biochemical fistula, 5 patients (5.0%) with a grade B pancreatic fistula, and 1 patient (1.0%) with a grade C pancreatic fistula. There were 2 patients (3.0%) with bile leakage, 7 patients (6.9%) with intra-abdominal bleeding, 4 patients (4.0%) with delayed gastric emptying, 6 patients (5.9%) with abdominal infection, 3 patients (3.0%) with pulmonary infection, 2 patients (2.0%) with intestinal obstruction, 3 patients (3.0%) required a repeated operation, and 1 patient (1.0%) with death in hospital within 30 days after surgery. Conclusions The laparoscopic assistant should have the perspective of one axis, two sides and four regions in LPD, and warn the operator to ensure the safety and fluency of the operation by clearly exposing important blood vessels and organs when performing the Kocher incision and when dissecting the key parts such as the dangerous triangle of the uncinate process. During anastomosis, the laparoscopic assistant should appropriately adjust the distance of vision, clearly reveal the surgical field of the anastomotic area, and help the surgeon in improving the precision of the suture and the quality of the anastomosis. Key words: Pancreaticoduodenectomy; Laparoscopes; Laparoscopic assistant; Coordination process

Is there any differences in post-operative course among the three main types of periampullary tumour?

Background and objectives: There have been many reports of pancreaticoduodenectomy performed for the surgical treatment of periampullary cancer. However, any differences in the perioperative courses of different types of periampullary tumour are unclear. In this study, we evaluated the differences in morbidity among the three main types of periampullary tumour. Methods: Prospectively collected data from patients who underwent pancreaticoduodenectomy for periampullary tumour between 2004 to 2018 were reviewed. The patients were divided into three groups: those with pancreatic head cancer, ampulla of Vater (AOV) cancer, or distal common bile duct (CBD) cancer. Results: Among the 645 patients who underwent pancreaticoduodenectomy, 298 (46.2%) were diagnosed with pancreatic head cancer, 172 (26.7%) with AOV cancer, and 175 (27.1%) with distal CBD cancer. The group with distal CBD cancer had the highest mean age (68.45 ± 9.2 years; p = 0.002) and the highest total bilirubin level (8.72 ± 0.6) mg/dl among the three groups. The group with pancreatic head cancer had the highest rate of firm pancreatic texture (71.7%) and the greatest duct diameter (4.64 ± 0.2 mm) among the three groups. Pancreatic fistula and pulmonary complications were more frequent in the groups with AOV cancer and distal CBD cancer. Post-operative haemorrhage occurred at a higher rate in the group with distal CBD cancer (12%). The hospital stay was longer in the group with distal CBD cancer (27.30 ± 1.3 days). Conclusion: Among the three main types of periampullary tumour, the group with distal CBD cancer had the highest complication rate and the longest hospital stay.

Robotic pancreaticoduodenectomy with right hepatic artery resection

Background: Pancreaticoduodenectomy(PD) with en bloc hepatic arterial resection and reconstruction remains a controversial topic. Although use of robotic surgery has been increasing worldwide in patients requiring PD, hepatic arterial resection and reconstruction has not been previously described. This video depicts a first in utilizing the Davinci Si robotic system to perform a hepatic arterial vascular resection and anastomosis during PD. Methods: A 69 year-old female, presenting with obstructive jaundice, was diagnosed with a distal common bile duct cancer by ERCP and brushing cytology. CT scan imaging revealed the suspected tumor mass involving the proximal right hepatic artery. We performed a total robotic PD. Right hepatic artery (RHA) was involved by the tumor and segmental resection was performed to achieve en bloc resection. End-to-end anastomosis of RHA stump to distal part was carried out by using 5-0 proline suture robotically. The reconstruction, including the modified Blumgart fashion pancreatojejunostomy, choledochojejunostomy and gastrojejunostomy, were all accomplished intracorporeally using the robotic platform. Results: The total operative time was 499 minutes and estimated blood loss was 500ml. The patient was discharged on post-OP day 4 without complications. The final pathology was moderately differentiated pancreatic adenocarcinoma with extensive perineural invasion. Metastatic carcinoma was found in one of the ten lymph nodes. Conclusion: PD with hepatic artery resection and reconstruction can be performed safely using robotic surgery. Restoration of the resected hepatic artery may ensure the bilio-enteric anastomosis in the immediate and late post-operative course.

Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study

ERCP-guided biliary drainage (ERCP-BD) is a criterion standard treatment for malignant biliary obstruction when curative surgery is not an option. Alternative methods such as percutaneous transhepatic biliary drainage would significantly lower the quality of life. EUS-guided biliary drainage (EUS-BD) has been developed and performed by experienced endoscopists. Therefore, the aims of this studywere to evaluate the efficacy and safety of EUS-BD compared with ERCP in malignant biliary obstruction. The prospective randomized controlled study was conducted, and 30 patients were enrolled: 15 for each EUS-BD and ERCP-BD arms. The technical success, procedural time, clinical success, and adverse events were evaluated. Thirty patients had extrahepatic malignant biliary tract obstruction (19 men, 11 women). Twenty-seven patients had unresectable pancreatic ductal adenocarcinomas, 1 patient had distal common bile duct cancer, and 2 patients had metastatic malignant lymphadenopathy. There were no significant differences both in terms of technical success rate and clinical success rate (100% vs 93% and 93% vs 100% in ERCP-BD vs EUS-BD, respectively; P= 1.00, P= 1.00). Four patients (31%) had tumor ingrowth-caused stent dysfunction in the ERCP-BD group, whereas 2 patients had food impaction and 2 patients had stent migration in the EUS-BD group. No significant procedure-related adverse events occurred in either group. This prospective randomized controlled study suggests that EUS-BD has similar safety to ERCP-BD. EUS-BD was not superior to ERCP-BD in terms of relief of malignant biliary obstruction. EUS-BD may have fewer cases of tumor ingrowth but may also have more cases of food impaction or stent migration. (Clinical trial registration number: NCT01421836.).

Bile duct segmental resection versus pancreatoduodenectomy for middle and distal common bile duct cancer.

PurposeTo compare survival outcomes between bile duct segmental resection (BDR) and pancreatoduodenectomy (PD) for the treatment of middle and distal bile duct cancer.MethodsFrom 1997 to 2013, a total of 96 patients who underwent curative intent surgery for middle and distal bile duct cancer were identified. The patients were divided into 2 groups based on the type of operation; 20 patients were included in the BDR group and 76 patients were in the PD group. We retrospectively reviewed the clinical outcomes.ResultsThe number of lymph nodes (LNs) was significantly greater in patients within the PD group compared to the BDR group. The total number of LNs was 6.5 ± 8.2 vs. 11.2 ± 8.2 (P = 0.017) and the number of metastatic LNs was 0.4 ± 0.9 vs. 1.0 ± 1.5 (P = 0.021), respectively. After a median follow-up period of 24 months (range, 4–169 months), the recurrence-free survival of the PD group was superior to that of the BDR group (P = 0.035). In the patients with LN metastases, the patients undergoing PD had significantly better survival than the BDR group (P < 0.001).ConclusionSurgeons should be cautious in deciding to perform BDR for middle and distal common bile duct cancer. PD is recommended if LN metastases are suspected.

Oncologic outcomes after radical surgery for periampullary cancer in octogenarians.

Backgrounds/AimsInterest in treatments for elderly patients has increased with life expectancy, and various studies have reported on the safety and feasibility of radical surgery in elderly patients with cancer. Here, we investigated oncologic outcomes of periampullary cancer in octogenarians.MethodsWe retrospectively reviewed medical records of 68 patients over 80 years of age who were diagnosed with periampullary cancer and were eligible for surgery; we analyzed overall survival (OS) and immediate postoperative complications and mortality.ResultsThere were no significant differences in mean age, disease type, oncologic features, comorbidities, or nutritional status between the patients who had surgery and those who did not. Five patients (20.0%) had major postoperative complications, but there was no immediate postoperative mortality. Patients who had surgery (n=25) had better OS (29.3 months; 95% confidence interval [CI]: 5.6–53.0) than did those who did not (n=43, OS: 7.6 months; 95% CI: 3.2–12.0 months; p<0.001). Similarly, patients with distal common bile duct cancer who underwent surgery had better OS than those who did not (surgery group: n=13, OS: 29.3 months, 95% CI: 8.9–49.7; non-surgery group: n=15, OS: 5.7 months, 95% CI: 4.2–7.2 months; p=0.002).ConclusionsRadical surgery for octogenarian patients with periampullary cancer is safe, feasible, and expected to result in better survival outcomes, especially for patients with common bile duct cancer.

Common bile duct stones associated with pancreatobiliary reflux and disproportionate bile duct dilatation.

Occult pancreatobiliary reflux (PBR) in patients with a normal pancreatobiliary junction has been studied by various methods, but the exact etiology, mechanisms, and implications of this reflux have not yet been clarified. The aim of this study was to investigate the degree of PBR and patterns of biliary ductal dilatation in patients with acute calculous cholangitis by endoscopic retrograde cholangiopancreatography (ERCP).We retrospectively evaluated the degree of PBR and pattern of bile duct dilatation in patients with acute calculous cholangitis due to distal CBD (common bile duct) stones (Group A) as compared with patients with malignant CBD obstruction due to distal CBD cancer (Group B). All related data were prospectively collected. Bile juice was aspirated at the proximal CBD for measurement of biliary amylase and lipase before the injection of contrast dye. The diameters of the CBD and the peripheral intrahepatic duct (IHD) were calculated after contrast dye injection. Patients with pancreatobiliary maljunction and/or gallstone pancreatitis were excluded from the study.ERCP was performed on 33 patients with calculous cholangitis (Group A) and 12 patients with malignant CBD obstruction (Group B). Mean levels of bile amylase and lipase were significantly higher (P < .05) in group A (1387 and 6737 U/l, respectively) versus those in group B (32 and 138 U/l, respectively). Thirty patients in group A (90.9%) showed disproportionate dilatation (i.e., CBD was and IHD was not dilated), whereas only 4 patients in group B (33%) showed disproportionate dilatation.The results of this study suggest that patients with calculous cholangitis exhibit PBR that is associated with disproportionate bile duct dilatation.

Tissue MicroRNA profiles as diagnostic and prognostic biomarkers in patients with resectable pancreatic ductal adenocarcinoma and periampullary cancers

BackgroundThe aim of this study was to validate previously described diagnostic and prognostic microRNA expression profiles in tissue samples from patients with pancreatic cancer and other periampullary cancers.MethodsExpression of 46 selected microRNAs was studied in formalin-fixed paraffin-embedded tissue from patients with resected pancreatic ductal adenocarcinoma (n = 165), ampullary cancer (n=59), duodenal cancer (n = 6), distal common bile duct cancer (n = 21), and gastric cancer (n = 20); chronic pancreatitis (n = 39); and normal pancreas (n = 35). The microRNAs were analyzed by PCR using the Fluidigm platform.ResultsTwenty-two microRNAs were significantly differently expressed in patients with pancreatic cancer when compared to healthy controls and chronic pancreatitis patients; 17 miRNAs were upregulated (miR-21-5p, −23a-3p, −31-5p, −34c-5p, −93-3p, −135b-3p, −155-5p, −186-5p, −196b-5p, −203, −205-5p, −210, −222-3p, −451, −492, −614, and miR-622) and 5 were downregulated (miR-122-5p, −130b-3p, −216b, −217, and miR-375). MicroRNAs were grouped into diagnostic indices of varying complexity. Ten microRNAs associated with prognosis were identified (let-7 g, miR-29a-5p, −34a-5p, −125a-3p, −146a-5p, −187, −205-5p, −212-3p, −222-5p, and miR-450b-5p). Prognostic indices based on differences in expression of 2 different microRNAs were constructed for pancreatic and ampullary cancer combined and separately (30, 5, and 21 indices).ConclusionThe study confirms that pancreatic cancer tissue has a microRNA expression profile that is different from that of other periampullary cancers, chronic pancreatitis, and normal pancreas. We identified prognostic microRNAs and microRNA indices that were associated with shorter overall survival in patients with radically resected pancreatic cancer.

Metastasectomy for recurrent or metastatic biliary tract cancers: A single center experience.

To assess efficacy or long-term result of metastasectomy for recurrent or metastatic biliary tract carcinoma (BTC), we conducted a retrospective review of the outcomes of metastasectomy for recurrent or metastatic BTCs, comprising intrahepatic cholangiocellular carcinoma (IHCCC), proximal and distal common bile duct cancer (pCBDC and dCBDC), gallbladder cancer (GBC), and ampulla of Vater cancer (AoVC). The clinicopathological features and outcomes of BTC patients who underwent surgical resection for the primary and metastatic disease at the Gachon University Gil Medical Centre from 2003 to 2013 were reviewed retrospectively. We found 19 eligible patients. Primary sites were GBC (seven patients, 37%), IHCCC (five patients, 26%), dCBDC (three patients, 16%), pCBDC (two patients, 11%), and AoVC (two patients, 11%). Eight patients (42%) had synchronous metastasis whereas 11 (58%) had metachronous metastasis. The most common metastatic site was liver (nine patients, 47%), lymph node (nine patients, 47%), and peritoneum (three patients, 16%). Nine patients (47%) achieved R0 resection, whereas four (21%) and six (32%) patients had R1 and R2 resection, respectively. With a median follow-up period of 26.7 months, the estimated median overall survival (OS) was 18.2 months (95% confidence interval, 13.6-22.9 months). Lower Eastern Cooperative Oncology Group performance status (P = 0.023), metachronous metastasis (P = 0.04), absence of lymph node metastasis (P = 0.009), lower numbers of metastatic organs (P < 0.001), normal postoperative CA19-9 level (P = 0.034), and time from diagnosis to metastasectomy more than 1 year (P = 0.019) were identified as prognostic factors for a longer OS after metastasectomy. For recurrent or metastatic BTCs, metastasectomy can be a viable option for selected patients.

A pilot study of concurrent chemoradiotherapy with gemcitabine and cisplatin in patients with locally advanced biliary tract cancer.

Combination chemotherapy with gemcitabine and cisplatin is a standard treatment for patients with advanced biliary tract cancer. This study aimed to evaluate the efficacy and safety of gemcitabine- and cisplatin-based concurrent chemoradiotherapy in patients with unresectable biliary tract cancer. Patients with pathologically proven, unresectable, non-metastatic biliary tract cancer were enrolled. Gemcitabine was administered intravenously at a dose of 1000mg/m(2) on days 1, 8, and 15. Cisplatin was administered intravenously at a dose of 70mg/m(2) on day 1. All the patients underwent concurrent radiotherapy with 45Gy in 1.8-Gy daily fractions. After treatment completion, tumor response was evaluated by using computed tomography. Eighteen patients were enrolled between June 2007 and October 2011. Their median age was 61years (range, 38-72years). Eight patients (44.5%) were diagnosed with gallbladder cancer, six (33.3%) with Klatskin's tumor, and four (22.2%) with distal common bile duct cancer. After treatment completion, partial response was achieved in five patients (27.8%) and stable disease in 13 patients (72.2%). The overall response rate was 27.8%, and the disease stabilization rate was 100%. No grade 4 adverse events or treatment-related deaths occurred. The most common grade 3 adverse events were thrombocytopenia (33.3%) and anemia (11.1%). The median progression-free and overall survival times were 6.8months (range, 4.5-19.8months) and 9.6months (5.4-30.4months), respectively. This study shows that gemcitabine- and cisplatin-based concurrent chemoradiotherapy is feasible and tolerable in patients with unresectable and non-metastatic biliary tract cancer.