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Palliative Treatments

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Surgical Treatment of Hilar and Intrahepatic Cholangiocarcinoma

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

The principal end-point of treatment of cholangiocarcinoma is resection with negative margins, but this goal fails in one-half to two-thirds of case [1,2]. Only Nimura’s group reports a resectability rate of 80% [1–3]. Therefore most patients with cholangiocarcinoma need palliative treatment of jaundice; moreover, local recurrence with relapse of jaundice, which is the most frequent problem after surgery, also requires palliation.

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References

  1. Chari RS, Anderson CA, Saverese DMF (2003) Treatment of cholangiocarcinoma II. In: Rose BD (ed) UpToDate. UpToDate, Wellesley, MA

    Google Scholar 

  2. Vauthey JN, Blumgart LH (1994) Recent advances in the management of cholangiocarcinomas. Semin Liver Dis 14(2):109–114

    Article  CAS  Google Scholar 

  3. Nimura Y, Kamiya J, Kondo S et al (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7(2):155–162

    Article  CAS  Google Scholar 

  4. Abraham NS, Barkun JS, Barkun An (2002) Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 56(6):835–841

    Article  Google Scholar 

  5. Bismuth H, Malt RA (1979) Current concepts in cancer: carcinoma of the biliary tract. N Engl J Med 301(13):704–706

    Article  CAS  Google Scholar 

  6. Dowsett JF, Vaira D, Hatfield AR et al (1989) Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology 96(4):1180–1186

    Article  CAS  Google Scholar 

  7. Traynor O, Castaing D, Bismuth H (1987) Left intrahepatic cholangio-enteric anastomosis (round ligament approach): an effective palliative treatment for hilar cancers. Br J Surg 74(10):952–954

    Article  CAS  Google Scholar 

  8. Singhal D, van Gulik TM, Gouma DJ (2005) Palliative management of hilar cholangiocarcinoma. Surg Oncol 14(2):59–74

    Article  CAS  Google Scholar 

  9. Abu-Hamda EM, Baron TH (2004) Endoscopic management of cholangiocarcinoma. Semin Liver Dis 24(2):165–175

    Article  Google Scholar 

  10. Anderson CD, Pinson CW, Berlin J, Chari RS (2004) Diagnosis and treatment of cholangiocarcinoma. Oncologist 9(1):43–57

    Article  Google Scholar 

  11. Gerhards MF, van Gulik TM, Gonzalez Gonzalez D et al (2003) Results of postoperative radiotherapy for resectable hilar cholangiiocarcinoma. World J Surg 27(2):173–179

    PubMed  Google Scholar 

  12. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366(9493):1303–1314

    Article  Google Scholar 

  13. Shapiro MJ (1995) Management of malignant biliary obstruction: nonoperative and palliative techniques. Oncology 9(6):493–496, discussion 499–500, 503

    CAS  PubMed  Google Scholar 

  14. England RE, Martin DF (1996) Endoscopic and percutaneous interevention in malignant obstructive jaundice. Cardiovasc Intervent Radiol 19(6):381–387

    Article  CAS  Google Scholar 

  15. Nelsen KM, Kastan DJ, Shetty PC et al (1996) Utilization pattern and efficacy of nonsurgical techniques to establish drainage for high biliary obstruction. J Vasc Interv Radiol 7(5):751–756

    Article  CAS  Google Scholar 

  16. Cowling MG, Adam AN (2001) Internal stenting in malignant biliary obstruction. World J Surg 25(3):355–359; discussion 359–361

    Article  CAS  Google Scholar 

  17. Lillemoe KD, Cameron JL (2000) Surgery for hilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobiliary Pancreat Surg 7(2):115–121

    Article  CAS  Google Scholar 

  18. Liu CL, Lo CM, Lai EC, Fan ST (1998) Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumours. Arch Surg 133(3):293–296

    Article  CAS  Google Scholar 

  19. De Palma GD, Galloro G, Siciliano S et al (2001) Unilateral verus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 53(6):547–553

    Article  Google Scholar 

  20. Venbrux AC (2001) Current status of endoscopic pancreaticobiliary interventions. J Vasc Interv Radiol 12:155–162

    Article  Google Scholar 

  21. Davids PH, Groen AK, Rauws EA et al (1992) Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340(8834–8835): 1488–1492

    Article  CAS  Google Scholar 

  22. Kaassis M, Boyer J, Dumas R et al (2003) Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57(2):178–182

    Article  Google Scholar 

  23. Prat F, Chapat O, Ducot B et al (1998) A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc 47(1):1–7

    Article  CAS  Google Scholar 

  24. Wagner HJ, Knyrim K, Vakil N, Klose KJ (1993) Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy 25(3):213–218

    Article  CAS  Google Scholar 

  25. Glattli A, Stain SC, Baer HU et al (1993) Unresectable malignant biliary obstruction: treatment by self-expandable biliary endoprostheses. HPB Surg 6(3):175–184

    Article  CAS  Google Scholar 

  26. Cheng JL, Bruno MJ, Bergman JJ et al (2002) Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents. Gastrointest Endosc 56(1):33–39

    Article  Google Scholar 

  27. Deviere J, Baize M, de Toeuf J, Cremer M (1988) Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 34(2):95–101

    Article  CAS  Google Scholar 

  28. Inal M, Akgul E, Aksungur E, Seydaoglu G (2003) Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol 14(11):1409–1416

    Article  Google Scholar 

  29. Watanapa P (1996) Recovery patterns of liver function after complete and partial surgical biliary decompression. Am J Surg 171(2):230–234

    Article  CAS  Google Scholar 

  30. Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140(2):170–178

    CAS  Google Scholar 

  31. Blumgart LH, Kelley CJ (1984) Hepaticojejunostomy in benign and malignant high bile duct stricture: approaches to the left hepatic ducts. Br J Surg 71(4):257–261

    Article  CAS  Google Scholar 

  32. Connors S, Wigmore SJ, Madhavan KK et al (2005) Surgical palliation for unresectable hilar cholangiocarcinoma. HPB Surg 7:273–277

    Article  Google Scholar 

  33. Jarnagin WR, Burke E, Powers C et al (1998) Intrahepatic biliary enteric bypass provides effective palliation in selected patients with malignant obstruction at the hepatic, duct confluence. Am J Surg 175(6):453–460

    Article  CAS  Google Scholar 

  34. Chaudhary A, Dhar P, Tomey S et al (1997) Segment III cholangiojejunostomy for carcinoma of the gallbladder. World J Surg 21(8):866–870: discussion 870–871

    Article  CAS  Google Scholar 

  35. Guthrie CM, Banting SW, Garden OJ, Carter DC (1994) Segment III cholangio jejunostomy for palliation of malignant hilar obstruction. Br J Surg 81(11):1639–1641

    Article  CAS  Google Scholar 

  36. Kapoor VK, Pradeep R, Haribhakti SP et al (1996) Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder. Br J Surg 83(12):1709–1711

    Article  CAS  Google Scholar 

  37. Launois B, Reding R, Lebeau G, Buard JL (2000) Surgery for hilar cholangiocarcinoma: French experience in a collective survey of 552 extrahepatic bile duct cancers. J Hepatobiliary Pancreat Surg 7(2):128–134

    Article  CAS  Google Scholar 

  38. Jarnagin WR, Fong Y, DeMatteo RP et al (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234(4):507–517: discussion 517–519

    Article  CAS  Google Scholar 

  39. Berr F, Wiedmann M, Tannapfel A et al (2000) Photodynamic therapy for advanced bile duct cancer: evidence for improved palliation and extended survival. Hepatology 31(2):291–298

    Article  CAS  Google Scholar 

  40. Kajanti M, Pyrhonen S (1994) Epirubicin-sequential methotrexate-5-fluorouracil-leucovorin treatment in advanced cancer of the extrahepatic biliary system. A phase II study. Am J Clin Oncol 17(3):223–226

    Article  CAS  Google Scholar 

  41. Takada T, Kato H, Matsushiro T et al (1994) Comparison of 5-fluorouracil, doxorubicin and mitomycin C with 5-fluorouracil alone in the treatment of pancreatic-biliary carcinomas. Oncology 51(5):396–400

    Article  CAS  Google Scholar 

  42. Mazhar D, Stebbing J, Bower M (2006) Chemotherapy for advanced cholangio carcinoma: what is standard treatment? Future Oncol 2(4):509–514

    Article  CAS  Google Scholar 

  43. Thongprasert S (2005) The role of chemotherapy in cholangiocarcinoma. Ann Oncol 16(Suppl 2):ii93–ii96

    Article  Google Scholar 

  44. Patt YZ, Hassan MM, Lozano RD et al (2001) Phase II trial of cisplatin, interferon alpha-2b, doxorubicin, and 5-fluorouracil for biliary tract cancer. Clin Cancer Res 7(11):3375–3380

    CAS  PubMed  Google Scholar 

  45. Patt YZ, Jones DV Jr, Hoque A et al (1996) Phase II trial of intravenous fluorouracil and subcutaneous interferon alfa-2b for biliary tract cancer. J Clin Oncol 14(8):2311–2315

    Article  CAS  Google Scholar 

  46. Ellis PA, Norman A, Hill A et al (1995). Epirubicin, cisplatin and infusional 5-fluorouracil (5-FU) (ECF) in hepatobiliary tumours. Eur J Cancer 31A(10):1594–1598

    Article  CAS  Google Scholar 

  47. Glimelius B, Hoffman K, Sjoden PO et al (1996) Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol 7(6):593–600

    Article  CAS  Google Scholar 

  48. Cantore M, Mambrini A, Fiorentini G et al (2005) Phase II study of hepatic intraarterial epirubicin and cisplatin, with systemic 5-fluorouracil in patients with unresectable biliary tract tumours. Cancer 103(7):1402–1407

    Article  CAS  Google Scholar 

  49. Mezger J, Sauerbruch T, Ko Y et al (1998) Phase II trial of gemcitabine in gallbladder and biliary tract carcinomas. Onkologie 21:232–234

    Google Scholar 

  50. Dobrila-Dintinjana R, Kovac D, Depolo A et al (2000) Gemcitabine in patients with nonre-sectable cancer of the biliary system or advanced gallbladder cancer. Am J Gastroenterol 95:2476

    Google Scholar 

  51. Kuhn R, Hribaschek A, Eichelmann K et al (2002) Outpatient therapy with gemcitabine and docetaxel for gallbladder, biliary, and cholangio-carcinomas. Invest New Drugs 20(3):351–356

    Article  CAS  Google Scholar 

  52. Carraro S, Servienti PJ, Bruno MF (2001) Gemcitabine and cisplatin in locally advanced or metastatic gallbladder and bile duct adenocancer. Proc Am Soc Clin Oncol 20:146B (abs 2333)

    Google Scholar 

  53. Doval DC, Sekhon JS, Gupta SK et al (2004) A phase II study of gemcitabine and cisplatin in chemotherapy-naive, unresectable gall bladder cancer. Br J Cancer 90(8):1516–1520

    Article  CAS  Google Scholar 

  54. Andre T, Tournigand C, Rosmorduc O et al: GER COR Group (2004) Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GER COR study. Ann Oncol 15(9):1339–1343.

    Article  CAS  Google Scholar 

  55. Shinchi H, Takao S, Nishida H, Aikou T (2000) Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma. J Surg Oncol 75(2):89–94

    Article  CAS  Google Scholar 

  56. Ishii H, Furuse J, Nagase M et al (2004) Relief of jaundice by external beam radiotherapy and intraluminal brachytherapy in patients with extrahepatic cholangiocarcinoma: results without stenting. Hepatogastroenterology 51(58):954–957

    PubMed  Google Scholar 

  57. Ohnishi H, Asada M, Shichijo Y et al (1995) External radiotherapy for biliary decompression of hilar cholangiocarcinoma. Hepatogastroenterology 42(3):265–268

    CAS  PubMed  Google Scholar 

  58. Crane CH, Macdonald KO, Vauthey JN et al (2002) Limitations of conventional doses of chemoradiation for unresectable biliary cancer. Int J Radiat Oncol Biol Phys 53(4):969–974

    Article  Google Scholar 

  59. Kuvshinoff BW, Armstrong JG, Fong Y et al (1995) Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy. Br J Surg 82(11):1522–1525

    Article  CAS  Google Scholar 

  60. Vallis KA, Benjamin IS, Munro AJ et al (1996) External beam and intraluminal radiotherapy for locally advanced bile duct cancer: role and tolerability. Radiother Oncol 41(1):61–66

    Article  CAS  Google Scholar 

  61. Foo ML, Gunderson LL, Bender CE, Buskirk SJ (1997) External radiation therapy, and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys 39(4):929–935

    Article  CAS  Google Scholar 

  62. Ortner MA, Liebetruth J, Schreiber S et al (1998) Photodynamic therapy of nonresectable cholangiocarcinoma. Gastroenterology, 114(3):536–542

    Article  CAS  Google Scholar 

  63. Ortner ME, Caca K, Berr F et al (2003) Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 125(5):1355–1363

    Article  Google Scholar 

  64. Witzigmann H, Berr F, Ringel U et al (2006) Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg244(2):230–239

    Article  Google Scholar 

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Authors and Affiliations

  1. General Surgery A, Department of Surgery and Gastroenterology, University Hospital G.B. Rossi, Verona, Italy

    Alfredo Guglielmi, Andrea Ruzzenente & Calogero Iacono

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  1. Alfredo Guglielmi
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  2. Andrea Ruzzenente
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  3. Calogero Iacono
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Guglielmi, A., Ruzzenente, A., Iacono, C. (2008). Palliative Treatments. In: Surgical Treatment of Hilar and Intrahepatic Cholangiocarcinoma. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-0729-1_16

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  • DOI: https://doi.org/10.1007/978-88-470-0729-1_16

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  • Online ISBN: 978-88-470-0729-1

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