Role of radical resection in patients with gallbladder carcinoma and jaundice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gallbladder carcinoma (GBC) is a commonly-seen malignancy of the biliary tract characterized by difficult early diagnosis, rapid growth, early metastasis, and poor prognosis. Nearly half of GBC patients also have jaundice, which is a mark of the advanced stage of GBC. The role of radical resection in patients of gallbladder carcinoma with jaundice is still a matter of uncertainty, which we attempted to clarify in this study.</p><p><b>METHODS</b>Totally, 251 GBC patients who received treatment at the Eastern Hepatobiliary Surgery Hospital (EHBH) from December 2002 to January 2010 were recruited into this study. We divided them into group A (jaundice group, n=117) and group B (non-jaundice group, n=134). Clinical records and follow-up data were collected and retrospectively analyzed in both groups.</p><p><b>RESULTS</b>Compared with group A, patients in group B had a longer median survival time ((6.0±0.5) months vs. (15.0±2.6) months, P<0.01). Even in patients with stage III or stage IV GBC, the median survival time in patients without jaundice (n=111), was still longer than that in patients with jaundice (n=116) (P<0.01). The radical resection rate was lower in group A patients than in group B patients with stage III or stage IV GBC; 31.9% vs. 63.1%. However, the median survival time of patients undergoing radical resection did not show a statistical difference between jaundice patients and non-jaundice patients; (12.0±4.3) months vs. (18.0±3.0) months (P>0.05).</p><p><b>CONCLUSIONS</b>GBC with jaundice usually implies advanced stage disease and a poor prognosis for the patients. However, our findings indicate that as long as the patient's condition allows, radical resection is still feasible for GBC patients with jaundice, and may achieve a prognosis close to those GBC patients without jaundice.</p>

Analysis of the relation between surgery and prognosis of hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it.</p><p><b>METHODS</b>A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 56. Jaundice (94.5%), pruritus (56.6%) and abdominal pain (33.8%) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type IIIa cases, 15 type IIIb cases, 112 type IV cases and 26 unclassifiable cases. One hundred and forty four cases received open operative treatment, and the others only were treated with endoscopic approach (including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage (2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%, included radical resection 59 cases (41.0%). Twenty-four cases underwent paunched biliary exploration and drainage.</p><p><b>RESULTS</b>The Cox's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival of biliary drainage group, palliative resection group and radical resection group, which statistically differed pairwise. Between ERBD or EMBE group and palliative resection group, there was no statistical difference. So was between ERBD or EMBE group and biliary drainage group, or between ENBD group and biliary drainage group. The survival differed statistically between ERBD or EMBE group and ENBD group.</p><p><b>CONCLUSIONS</b>Operative procedure was the most important prognosic factor of hilar cholangiocarcinoma, radical resection still was the primary measure to cure and long term survival. For irresectable hilar cholangiocarcinoma, the effect of ERBD or EMBE could not be considered to be worse than that of open operative treatment.</p>

Partial hepatectomy with skeletonization of the hepatoduodenal ligament for hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To sum up author's experience and to define the role of partial hepatectomy with skeletonization resection in the treatment of hilar cholangiocarcinoma.</p><p><b>METHODS</b>Between January 1999 and December 2001, 67 patients underwent exploration in our hospital. The clinical records of these patients were reviewed.</p><p><b>RESULTS</b>Sixty-five (97%) patients underwent surgical resection. Forty-nine patients (73%) had curative resection [22 skeletonization resection (SR), and the other 27 undergone SR combined with partial hepatectomy]. According to the Bismuth-Corlett classification, tumors were classified into four types. SR was performed in type I (5 cases) and type II (17 cases). Right lobectomy with right caudate lobectomy was performed in type IIIa (6 cases), left lobectomy with left caudate lobectomy in type IIIb (15 cases). Right lobectomy with whole caudate lobectomy (3 cases), left lobectomy with whole caudate lobectomy (9 cases), and quadrate lobectomy (2 cases) were undertaken in type IV. We successfully did SR and left lobectomy with whole caudate lobectomy in 2 patients (3%) who had suffered palliative biliary cancer resection and cholangiojejunostomy before. Eight patients (12%) had local resection of the tumor with Roux-en-Y hepaticojejunostomy reconstruction and intrahepatic bile ducts support. Two patients (3%) had palliative biliary drainage. Combined portal vein resection was performed in 13 (20%) patients and hepatic artery resection in 27 (40.3%). Twenty-four (35.8%) patients had no postoperative complications, and 20 (30.2%) patients developed major complications. Of the 20 patients with major complications 14 recovered; the remaining 6 patients died of liver-renal failure with other organ failure or of heart attack, intraabdominal bleeding, and gastrointestinal bleeding in 7, 12, 14, 42, 57, or 89 days after surgery. Thirty days operative mortality was 4.5%. The median survival of patients with curative resection was 16 months (ranging from 1 to 41 months), while the median survival with palliative operation was 7 months (ranging from 1 to 16 months).</p><p><b>CONCLUSIONS</b>Partial hepatectomy with skeletonization resection for hilar cholangiocarcinoma can be performed with acceptable morbidity and mortality. For curative treatment of hilar cholangiocarcinoma, Caudate lobectomy is always recommended in Bismuth type III/IV.</p>

Prognostic analysis of patients suffering from distal bile duct cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study prognostic factors after surgical procedure for distal bile duct cancer.</p><p><b>METHODS</b>A retrospective clinical analysis was made in 173 cases of distal bile duct cancer, admitted to our hospital from February 1996 to December 2002. Fourteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model.</p><p><b>RESULTS</b>There were 99 males and 74 females. The age ranged from 27 to 74 years old with a mean of 55.5. Radical resection was performed on 152 cases with radical resection rate of 87.9%. 29 cases died of liver metastasis with a rate of 46.8% in total death cases. The statistical analysis showed that surgical procedure, lymph node metastasis and pathological differentiation grade affected postoperative survival significantly, but transfusion, invasion of pancreas, postoperative radiotherapy and chemotherapy, ERCP, diameter of tumour, serum level of CA-19-9, preoperative total serum bilirubin level (TBIL), ratio of albumin to globulin (A/G), sex and age are not significant factors influencing postoperative survival.</p><p><b>CONCLUSIONS</b>Radical resection is only curative treatment modality. Aggressive treatment and prevention on postoperative liver metastasis is a important strategy to improve the survival for distal bile duct cancer.</p>