Surgery, Gastroenterology and Oncology

Read article While relatively infrequent, cholangiocarcinomas (CCAs) are liver cancers whose incidence is increasing worldwide.Unfortunately, the progress in medical, surgical and radiation oncology treatment of CCAhas made little strides in the survival of patients in most regions of the world over the past several decades.
As a result, CCA therapy remains a major challenge in medicine. There are multiple reasons for limited advances in CCA care. These include:
(1) the lack of standardized surgical approaches,
(2) the relatively difficulty of conducting clinical trials due to t....[more]

Read article Perihilar cholangiocarcinoma (PCC) is a devastating disease with poor prognosis. Surgical resection remains a first-line therapy in patients with PCC, and the primary goal is to gain a tumor-free surgical margin.

However, surgical margins are sometimes involved after curative intent surgery even now, which is plausibly explained by the fact that there is a potential gap between the extent of radiologic tumor staging and that of histologic cancer invasion.
It is known that cancer cells of cholangiocarcinoma invade the surrounding area beyond the gross tumor border. The....[more]

Read article The indications for liver transplantation in hepatobiliary malignancies have been carefully expanded, giving rise to a new era of Transplant Oncology, the fusion of transplantation medicine and oncology.
Curative resection is the only curative therapy for perihilar cholangiocarcinoma. Liver transplantation may achieve a complete resection with adequate negative margins in patients with locally advanced, unresectable disease due to bilateral invasion of second-order biliary radicals, portal vein and or hepatic artery involvement, or insufficient hepatic reserve.
An aggress....[more]

Read article Cholangiocarcinoma is a fatal cancer arising from the biliary endothelium. Perihilar cholangiocarcinoma (pCCA) is the most common variant of cholangiocarcinoma, with increasing incidence worldwide.
Most pCCA patients present with unresectable disease at the time of diagnosis, and many patients are found to be unresectable after surgical exploration. pCCA carries a poor prognosis as more than 65% of the patients are presented with non-resectable disease at the time of diagnosis, and about 10% to 45% of patients are found to be unresectable after surgical exploration.
Surgi....[more]

Read article Surgical resection with negative margins is the standard treatment for perihilar cholangiocarcinoma whenever possible. Patient's frequent low performance status at presentation and need of extended resections require optimization of the patient's condition in the preoperative setting. Biliary drainage is mandatory in case of cholangitis, jaundice-related liver insufficiency, malnutrition or renal failure.

Drainage is also necessary in case of portal vein embolization (PVE), in order to improve regeneration of the future liver remnant (FLR). Unilateral drainage of the FLR sh....[more]

Read article Intrahepatic cholangiocarcinoma (IHCC) is a common primary hepatic tumor. However, its outcomes are usually worse than those of hepatocellular carcinoma owing to its non-specific presentation and detection at an advanced stage.
Surgery is the best treatment option that offers a chance of long-term survival. Minimal invasive procedures for IHCC were not well performed frequently due to necessity for major laparoscopic liver resection (LLR) with possible inclusion of caudate resection (for Klatskin tumor), laparoscopic lymphadenectomy, and laparoscopic biliary-enteric anastomosis....[more]

Read article Mass-forming cholangiocarcinoma (MFCCC) is a disease at increasing incidence (1,2). Liver resection (LR) is the standard treatment, while chemotherapy has a limited effectiveness (3,4).
Five-year survival rates after complete surgery range between 20 and 35% (5-9). Although surgery represents the unique curative treatment, the disease is characterized by low resectability and high post-surgical recurrences rates (1-4). To date, resectability is based on morphological features (number and size of lesions, vascular invasion), lymphnode metastases (N stage), and surgical radicalit....[more]

Read article Unresectable cholangiocarcinoma represents a major therapeutic challenge and outcomes are still not satisfactory. However, there is the hope that recent developments in radiotherapy such as stereotactic body radiotherapy, proton therapy and brachytherapy are able to not only lead to better local control but also to prolong overall survival.

Specific bowel protection strategies such as simultaneous integrated protection are required to safely deliver the dose in situations where there is close proximity of the lesions to the bowel.
The integration of these techniques i....[more]

Read article Cholangiocarcinoma (CCA) is the second most common type of primary liver cancer, after hepatocellular carcinoma, and accounts for 10-25% of primary liver cancers (1, 2). CCAs are classified as intrahepatic CCA (iCCA) and extrahepatic CCA (eCCA), according to their anatomical location (3).
CCA is more frequent in South Asia compared to Western countries, because of the increased prevalence of established risk factors, including fluke infections (2). In the USA, the incidence of CCA has increased over the past three decades (4). Surgical resection and transplantation are the only....[more]

Read article Introduction: The knowledge of current approach and outcomes of curative-intent surgery for perihilar cholangiocarcinoma (PHC) has been highlighted in studies of the literature including mainly East Asian and Western patients.
Thus, papers presenting the curative-intent surgery in East Europe are scarce. The study aims to present the operative management and outcomes of curative-intent surgery for PHC in an East European institutional experience.

Patients and methods: The data of all patients with curative-intent surgery for PHC between 1996 and 2017 were ....[more]

Read article Extrahepatic cholangiocarcinoma is divided into two compartments, namely perihilar cholangiocarcinoma and distal cholangiocarcinoma. Hemihepatectomy and caudate lobectomy with resection of extrahepatic bile duct is usually performed for patients with perihilar cholangiocarcinoma, whereas pancreaticoduodenectomy is performed for distal cholangiocarcinoma.
As pancreaticoduodenectomy has been a well-established and more commonly performed operation, distal cholangiocarcinoma was thought to have better outcomes as compared to perihilar cholangiocarcinoma. However, both cholangiocarc....[more]

Read article Background. Perihilar cholangiocarcinoma (PCC), defined as tumors involving or in close vicinity to the main bile duct confluence, is the most frequent type of cholangiocarcinoma (CC). Nevertheless, PCC occurring on biliary anatomical variant is a rare condition, difficult to diagnose and to establish the proper surgical approach.

Case presentation. A 59-year old male, with normal liver function, is incidentally diagnosed with PCC of the left hepatic duct (LHD), associated with a biliary anatomical variant consisting in right posterior hepatic duct (RPHD) enter....[more]

Read article Intrahepatic cholangiocarcinoma (ICC) is usually diagnosed in advanced stages of disease, more than half of the patients being unresectable at the time of their diagnosis.
Moreover, the disease is very aggressive, almost half of untreated patients dying during the first 4 month after diagnosis. Even in patients who undergo curative-intent treatment, the prognosis is still modest, with median survival less than 30 months in most series.
Although this dismal prognosis is typical for ICC, some patients experience unusual long-term survival, even when poor clinico-pathologic pr....[more]