Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Diagnosis and Cure Experience of Hepatolithiasis-Associated Intrahepatic Cholangiocarcinoma in 66 Patients

  • Li, Hong-Yang (Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing University of Medical Sciences) ;
  • Zhou, Shi-Ji (Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing University of Medical Sciences) ;
  • Li, Min (Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing University of Medical Sciences) ;
  • Xiong, Ding (Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing University of Medical Sciences) ;
  • Singh, Akanand (Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing University of Medical Sciences) ;
  • Guo, Qing-Xi (Department of Pathology, Luzhou Medical College) ;
  • Liu, Chang-An (Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing University of Medical Sciences) ;
  • Gong, Jian-Ping (Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing University of Medical Sciences)
  • Published : 2012.02.29
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Abstract

Background: The management of hepatolithiasis combined with intrahepatic cholangicarcinoma (IHHCC) remains a challenge due to poor prognosis. The aim of this study was to summarize our diagnosis and cure experience of IHHCC over the recent 10 years. Methods: From January 1996 to January 2006, 66 patients with IHHCC were reviewed retrospectively. Results: Of the 66 patients, 52 underwent surgical resection (radical resection in 38 and palliative in 14) and 8 patients abdominal exploration, while the other 6 cases received endoscopic retrograde biliary internal drainage and stent implantation. In this series, correct diagnosis of advanced stage was made during operation in 8 cases (8/60, 13.3%) and all of them (underwent unnecessary abdominal exploration, among them the positive rate of CA19-9 was 100%, and the positive rate of CEA was 87.6% (7/8), incidence rate of ascites was 100% and short-term significant weight loss was 100%, with median overall survival of only 4 months. Conclusion: Radical resection is mandatory for IHHCC patient to achieve long-term survival, the CT and MR imaging features of IHHCC being concentric enhancement. Patients with IHHCC have significant higher CA199 and significant higher CEA and short-term significant weight loss and ascites should be considered with advanced stage of IHHCC and unnecessary non-therapeutic laparotomies should be avoided.

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References

  1. Chen MF, Jan YY, Hwang TL, Jeng LB, Yeh TS (2000). Impact of concomitant hepatolithiasis on patients with peripheral cholangiocarcinoma. Dig Dis Sci, 45, 312-6. https://doi.org/10.1023/A:1005460509677
  2. Chen YX, Zeng ZC, Tang ZY, et al (2010). Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 84 patients. BMC Cancer, 10, 492. https://doi.org/10.1186/1471-2407-10-492
  3. Choi JY, KimMJ, Lee JM, et al (2008). Magnetic resonance cholangiography: comparison of two- and three-dimensional sequences for assessment of malignant biliary obstruction. Eur Radiol, 18, 78-86. https://doi.org/10.1007/s00330-007-0670-6
  4. Connor S, Barron E, Redhead DN, et al (2007). Palliation for suspected unresectable hilar cholangiocarcinoma. Eur J Surg Oncol, 33, 341-5. https://doi.org/10.1016/j.ejso.2006.11.005
  5. Gaujoux S, Allen PJ (2010). Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy. World J Gastrointest Surg, 2, 283-90. https://doi.org/10.4240/wjgs.v2.i9.283
  6. Glockner JF (2007). Hepatobiliary MRI: current concepts and controversies. J Magn Reson Imaging, 25, 681-95. https://doi.org/10.1002/jmri.20844
  7. Han SL, Zhou HZ, Cheng J, et al (2009). Diagnosis and surgical treatment of intrahepatic hepatolithiasis associated cholangiocarcinoma. Asian J Surg, 32, 4-5.
  8. Jan YY, Yeh CN, Yeh TS, et al (2005). Prognostic analysis of surgical treatment of peripheral cholangiocarcinoma: two decades of experience at Chang Gung Memorial Hospital. World J Gastroenterol, 11, 1779-84. https://doi.org/10.3748/wjg.v11.i12.1779
  9. Kinjo N, Shimada M, Maeda T, et al (2005). Preoperatively undiagnosable intrahepatic bile duct dilatation contains early-stage intrahepatic cholangiocarcinoma. Hepatogastroenterology, 52, 1368-71.
  10. Kuroki T, Tajima Y, Kanematsu T (2005). Hepatolithiasis and intrahepatic cholangiocarcinoma: carcinogenesis based on molecular mechanisms. J Hepatobiliary Pancreat Surg, 12, 463-6. https://doi.org/10.1007/s00534-005-1004-1
  11. Lang H, Sotiropoulos GC, Brokalaki E, et al (2006). Surgical therapy of intrahepatic cholangiocellular carcinoma. Chirurg, 77, 53-60. https://doi.org/10.1007/s00104-005-1069-z
  12. Lazaridis KN, Gores GJ (2005). Cholangiocarcinoma. Gastroenterology, 128, 1655-67 https://doi.org/10.1053/j.gastro.2005.03.040
  13. Li YG, Zhang N (2009). Clinical significance of serum tumour M2-pk and CA19-9 detection in the diagnosis of cholangiocarcinoma. Dig Livor Dis, 44, 605-8.
  14. Morris-Stiff G, Bhati C, Olliff S, et al (2008). Cholangiocarcinoma complicating primary sclerosing cholangitis: a 24-year experience. Dig Surg, 25, 126-32. https://doi.org/10.1159/000128169
  15. Paik WH, Park YS, Hwang JH, et al (2009). Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach. Gastrointest Endosc, 69, 55-62. https://doi.org/10.1016/j.gie.2008.04.005
  16. Palmucci S, Mauro LA, CoppolinoM, et al (2010). Evaluation of the biliary and pancre-atic systemwith 2D SSFSE, breath-hold 3D FRFSE and respiratory-triggered 3DFRFSE sequences. Radio Med, 115, 467-82. https://doi.org/10.1007/s11547-010-0508-1
  17. Patel T, Singh P (2007). Cholangiocarcinoma: emerging approaches toa challenging cancer. Curr Opin Gastroenterol, 23, 317-23. https://doi.org/10.1097/MOG.0b013e3280495451
  18. 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, 3375-80.
  19. Saness, MacCallum JD (1952). Primary carcinoma of the liver cholangiocarcinoma in hepatolithiasis. Am J pathol, 18, 675-9.
  20. Schulick RD (2008). Primary sclerosing cholangitis: detection of cancer in strictures. J Gastrointest Surg, 12, 420-2. https://doi.org/10.1007/s11605-007-0345-2
  21. Shaib YH, Davila JA, Henderson L, McGlynn KA, El-Serag HB (2007). Endoscopic and surgical therapy for intrahepatic cholangiocarcinoma in the united states: a population-based study. J Clin Gastroenterol, 41, 911-7. https://doi.org/10.1097/MCG.0b013e31802f3132
  22. Sodickson A, Mortele KJ, BarishMA, et al (2006). Threedimensional fast-recovery fastspin-echoMRCP: comparisonwith two-dimensional single-shot fast spin-echo techniques. Radiology, 238, 549-59. https://doi.org/10.1148/radiol.2382032065
  23. Tanaka S, Yamamoto T, Tanaka H, et al (2005). Potentiality of combined hepatocellular and intrahepatic cholangiocellular carcinoma originating from a hepatic precursor cell: immunohistochemical evidence. Hepatol Res, 32, 52-7. https://doi.org/10.1016/j.hepres.2005.01.012
  24. Tischoff I, Tannapfel A (2007). Hepatocellular carcinoma and cholangiocarcinoma-different prognosis, pathogenesis and therapy. Zentralbl Chir, 132, 300-5. https://doi.org/10.1055/s-2007-981195
  25. Uenishi T, Yamazaki O, Yamamoto T, et al (2005). Serosal invasion in TNM staging of mass-forming intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg, 12, 479-83. https://doi.org/10.1007/s00534-005-1026-8
  26. Witzigmann H, Berr F, Ringel U, et al (2006). Surgical and pallia-tive management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg, 244, 230-9. https://doi.org/10.1097/01.sla.0000217639.10331.47
  27. Yeh TS, Tseng JH, Chen TC, et al (2005). Characterization of intrahepatic cholangiocarcinoma of the intraductal growthtype and its precursor lesions. Hepatology, 42, 657-64. https://doi.org/10.1002/hep.20837
  28. Zhou YM, Yin ZF, Yang JM, et al (2008). Risk factors for intrahepatic cholangiocarcinoma: a case-control study in China. World J Gastroenterol, 14, 632-5. https://doi.org/10.3748/wjg.14.632
  29. Zhou YM, Yang JM, et al (2008). Clinicopathologic characteristics of intrahepatic cholangiocarcinoma in patients with positive serum a-fetoprotein. World J Gastroenterol, 14, 2251-4. https://doi.org/10.3748/wjg.14.2251

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