Biliary tract cancer has insidious onset and high degree of malignancy, and radical resection is often impossible when it is diagnosed.Conversion therapy can achieve tumor downgrading, so that patients who were initially unresectable have a chance to achieve R0 resection.However, due to the high heterogeneity and complex immune microenvironment of biliary tract cancer, conversion therapy is still in the stage of active exploration.As a new type of conversion therapy, combination of targeted therapy and immunotherapy is of great significance to effectively improve the efficiency of conversion therapy.Further exploration of combination mechanism and improvement of immune microenvironment are expected to become the future direction of combination of targeted therapy and immunotherapy.
Antineoplastic Combined Chemotherapy Protocols ; Biliary Tract Neoplasms/surgery* ; Combined Modality Therapy ; Gastrectomy ; Humans ; Immunotherapy ; Tumor Microenvironment

OBJECTIVE: To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. MATERIALS AND METHODS: Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. RESULTS: A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). CONCLUSION: Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.
Adult ; Aged ; Aged, 80 and over ; Biliary Tract Neoplasms/surgery ; Cholangitis/etiology ; Cholestasis/*surgery ; Female ; Hemobilia/etiology ; Humans ; Kaplan-Meier Estimate ; Liver/blood supply/pathology/surgery ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Palliative Care/methods ; Polytetrafluoroethylene ; Portal Vein/pathology/*surgery ; Retinal Vein Occlusion/*surgery ; Retrospective Studies ; Stents/*adverse effects ; Treatment Outcome

As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.
Bile Duct Neoplasms/pathology/surgery ; Biliary Tract Diseases/pathology/*surgery ; Cholangiocarcinoma/pathology/surgery ; Decompression, Surgical ; Drainage/methods ; Endoscopy ; *Evidence-Based Medicine ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive/pathology/*surgery ; Klatskin's Tumor/pathology/surgery ; Stents

No abstract available.
Aged ; Biliary Tract Neoplasms/*pathology/surgery ; Cell Nucleus/pathology ; Female ; Humans

Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
Bile Ducts, Extrahepatic ; Biliary Tract Diseases/complications/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Duodenal Diseases/*diagnosis/etiology/therapy ; Female ; Gallbladder Neoplasms/diagnosis ; Humans ; Intestinal Perforation/*diagnosis/etiology/therapy ; Middle Aged ; Plastics ; Stents/*adverse effects ; Tomography, X-Ray Computed

OBJECTIVETo study the cytologic features of pancreatobiliary tumors in endoscopic retrograde cholangiopancreatography (ERCP)-guided brushing preparations and to evaluate the usefulness of cytology in the diagnosis of pancreatobiliary malignancy.

METHODSA retrospective analysis of 212 cases of ERCP-guided brush cytology smears performed during the period from January, 2004 to December, 2006. The cytologic diagnosis was confirmed either by the histologic diagnosis or the strict clinical criteria.

RESULTSTwo of the cases studied were unsatisfactory for diagnosis, with no epithelial cells identified. One hundred and thirty-seven smears were diagnosed as "negative", 45 of which subsequently confirmed to be malignant (negative predictive value = 60.2%). Six of the 11 cases with "low-grade atypia" were proven to be malignant (positive predictive value = 54.5%), as compared to 19 of 23 cases of "high-grade atypia" (positive predictive value = 86.4%). All of the 41 cases with cytologic diagnosis of "malignancy" were confirmed to be malignant (positive predictive value = 100%). The cytologic features of malignancy in ERCP-guided brushing preparations included overlapping nuclei, anisonucleosis, coarse chromatin pattern, poor cellular cohesion, tumor diathesis, prominent nucleoli and atypical mitotic figures.

CONCLUSIONSThe accuracy of ERCP-guided brush cytology relies on good specimen preparation and application of morphologic criteria. Grading of cytologic atypia is of clinical significance. A "negative" or "low-grade atypia" cytologic diagnosis requires further diagnostic workup to rule out the possibility of underlying malignancy, while a "high-grade atypia" or "malignant" diagnosis is relatively specific in guiding subsequent management of suspected pancreatobiliary malignancy.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biliary Tract Neoplasms ; diagnosis ; pathology ; surgery ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Cytological Techniques ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnosis ; pathology ; surgery ; Precancerous Conditions ; diagnosis ; pathology ; surgery ; Predictive Value of Tests ; Retrospective Studies ; Specimen Handling ; Young Adult

Adolescent ; Adult ; Aged ; Biliary Tract Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Papilloma ; diagnosis ; diagnostic imaging ; pathology ; surgery ; Radiography ; Young Adult

OBJECTIVETo analyze the surgical treatment result and clinical characteristics of hilar cholangiocarcinoma in order to improve the rate of early diagnosis and radical resection.

METHODSBetween 1986 and 2004,84 hilar cholangiocarcinoma patients underwent surgery, and their data were retrospectively reviewed.

RESULTSAccording to the Bismuth-Corlette staging system, 7 were type I, 18 type II, 22 type II a, 12 type IlI b, 20 type IV and 5 unclassified. 32 patients (38.1%) had had the history of operation for cholelithiasis before or were found to have cholelithiasis simultaneously at the time of diagnosis. The rate of making correct diagnosis by ultrasound, CT and MRCP was 71.4% , 84.0% and 91.4% , respectively. Of these 84 patients, 24 (28.6%) underwent radical resection, 14 (16.7%) palliative resection and 30 (35.7%) only internal or external drainage, while 16 patients was found to have contraindication for any further surgical intervention. The overall operation rate was 81.0% (68/84) with a radical resection rate of 35.3% (24/68). The 1-, 3- and 5-year survival rates was 70.8%, 50.0% and 20.8% in the radical resection group, and 50.0%, 21.4% and 0 in the palliative resection group, respectively. There was a statistically significant difference in the survival between two groups. Whereas in the internal or external drainage group, the 1-, 3- and 5-year survival rates was 20.0% ,10.0% and 0. All of the patients who did not undergo surgical intervention died within one year.

CONCLUSIONCholelithiasis may play an important role in the pathogenesis of hilar cholangiocarcinoma. Early diagnosis and radical resection are two important factors to improve the prognosis of hilar cholangiocarcinoma. Skeletonization of hepatoduodenal ligament with partial liver resection can improve the rate of radical resection for hilar cholangiocarcinoma.

Adenocarcinoma ; diagnosis ; surgery ; Adenocarcinoma, Mucinous ; diagnosis ; surgery ; Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; diagnosis ; surgery ; Bile Ducts, Intrahepatic ; Biliary Tract Surgical Procedures ; methods ; Cholangiocarcinoma ; diagnosis ; surgery ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis

Bile Duct Neoplasms ; surgery ; Bile Ducts ; pathology ; surgery ; Bile Ducts, Intrahepatic ; pathology ; surgery ; Biliary Tract Diseases ; surgery ; Biliary Tract Surgical Procedures ; methods ; trends ; Cholecystectomy, Laparoscopic ; methods ; trends ; Cholelithiasis ; surgery ; Humans

OBJECTIVETo summarize the experience in ameliorating curative resection rate and major postoperative complication rate for treatment of hilar cholangiocarcinoma.

METHODSRespective analysis was made on the clinical data of 54 consecutive cases who underwent resection of hilar cholangiocarcinoma from Jan. 1998 to Dec. 2004.

RESULTSIn this group 54 cases received tumor resection with a resection rate of 63.5%. Combined partial hepatectomy was performed in 14 patients, while combined pancreaticoduodenectomy (Whipple) in 3 patients, and combined resection of portal vein in 2 patients and combined resection of hepatic artery in 2 patients. Thirty patients had curative resection. The curative resection rate was greatly increased from 27.0% (before 2001) to 41.7% (after 2001) in this group with well controlled perioperative mortality and postoperative complications rate (e.g. hepatic failure and major infection). The gross 1-, 2-, and 3-year survival rates for the whole group were 67.4%, 28.1% and 13.5% respectively. The 1-, 2-, and 3-year survival rates for curative resection were 87%, 36% and 24% respectively. The 1-, 2-year survival rates for palliative resection were 42% and 18%.

CONCLUSIONSEnhanced surgical technique resulted in better clinical outcomes.

Adult ; Aged ; Anastomosis, Roux-en-Y ; Bile Duct Neoplasms ; mortality ; surgery ; Bile Ducts, Intrahepatic ; surgery ; Biliary Tract Surgical Procedures ; methods ; Cholangiocarcinoma ; mortality ; surgery ; Female ; Hepatectomy ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Survival Rate