A single-center analysis of the survival benefits of adjuvant gemcitabine chemotherapy for biliary tract cancer.

BACKGROUND: Surgical resection is the only curative treatment of biliary tract cancer (BTC). However, the prognosis of BTC remains unsatisfactory. The aim of this study is to evaluate the benefits of adjuvant gemcitabine chemotherapy for BTC. METHODS: We performed a historical cohort study that involved 198 patients who underwent R0 surgical resection. Patients who underwent major hepatectomy were administered biweekly intravenous gemcitabine at a dose of 800 mg/m(2). Otherwise, patients were administered intravenous gemcitabine at a dose of 1,000 mg/m(2) in 3 weekly infusions, which were followed by a 1-week pause. The primary outcome was overall survival. The hazard ratio (HR) of adjuvant chemotherapy was estimated by propensity score-stratified Cox regression that was adjusted for confounders. RESULTS: Forty patients received adjuvant chemotherapy. The HR of adjuvant chemotherapy was 0.47 [95 % confidence interval (CI) 0.28-0.95; P = 0.03]. Subgroup analysis showed that the survival benefits were possibly modified by lymph node positivity (HR 0.19; 95 % CI 0.07-0.58; interaction, P = 0.22), stage III (HR 0.11; 95 % CI 0.02-0.50; interaction, P < 0.01), intrahepatic cholangiocarcinoma (ICC) (HR 0.09; 95 % CI 0.01-0.67; interaction, P = 0.05), and poorly differentiated tumor (HR 0.16; 95 % CI 0.03-0.85; interaction, P = 0.13). CONCLUSIONS: Adjuvant gemcitabine chemotherapy for BTC may be effective, particularly for patients with stage III and ICC.

Prophylactic respiratory management after liver resection with bilevel positive airway pressure ventilation: Report of three cases.

Pulmonary complications after hepatectomy occur with relative frequency and are associated with increased morbidity and mortality. Moreover, their prevention is often difficult. We report using prophylactic bilevel positive airway pressure ventilation, initiated just after the operation, for the successful postoperative respiratory management of three patients predisposed to the development of pulmonary complications. One patient had insufficient pulmonary function (forced expiratory volume in 1 s (FEV(1)) 0.95 l; FEV(1)/forced vital capacity 40.8%) caused by previous thoracoplasty. The other two patients were obese and had obstructive sleep apnea syndrome (OSAS). None of the patients required endotracheal intubation after hepatectomy, although the two with severe OSAS suffered pulmonary thromboembolism postoperatively. Bilevel positive airway pressure ventilation was well tolerated and there were no adverse effects, suggesting its effectiveness for preventing pulmonary complications after hepatectomy.