DOCSLIB.ORG

(NCCN Guidelines®) Hepatobiliary Cancers

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
(NCCN Guidelines®) Hepatobiliary Cancers NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Hepatobiliary Cancers Version 2.2015 NCCN.org Continue Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:11:23 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 2.2015 Panel Members Hepatobiliary Cancers Table of Contents Hepatobiliary Cancers Discussion *Al B. Benson, III, MD/Chair † Renuka Iyer, MD Þ † Elin R. Sigurdson, MD, PhD ¶ Robert H. Lurie Comprehensive Cancer Roswell Park Cancer Institute Fox Chase Cancer Center Center of Northwestern University R. Kate Kelley, MD † ‡ Stacey Stein, MD, PhD *Michael I. D’Angelica, MD/Vice-Chair ¶ UCSF Helen Diller Family Yale Cancer Center/Smilow Cancer Hospital Memorial Sloan Kettering Cancer Center Comprehensive Cancer Center G. Gary Tian, MD, PhD † Thomas A. Abrams, MD † Mokenge P. Malafa, MD ¶ St. Jude Children’s Dana-Farber/Brigham and Women’s Moffitt Cancer Center Research Hospital/ Cancer Center The University of Tennessee James O. Park, MD ¶ Health Science Center Fred Hutchinson Cancer Research Center/ Steven R. Alberts, MD, MPH Seattle Cancer Care Alliance Mayo Clinic Cancer Center Jean-Nicolas Vauthey, MD ¶ Timothy Pawlik, MD, MPH, PhD ¶ The University of Texas Chandrakanth Are, MD ¶ The Sidney Kimmel Comprehensive MD Anderson Cancer Center Fred & Pamela Buffett Cancer Center at Cancer Center at Johns Hopkins The Nebraska Medical Center Alan P. Venook, MD † ‡ James A. Posey, MD † UCSF Helen Diller Family Mark Bloomston, MD ¶ University of Alabama at Birmingham Comprehensive Cancer Center The Ohio State University Comprehensive Cancer Center Comprehensive Cancer Center - Rebekah White, MD ¶ James Cancer Hospital and Vaibhav Sahai, MD, MS † Duke Cancer Institute Solove Research Institute University of Michigan ComprehensiveCancer Center Yun Yen, MD, PhD ‡ Daniel Brown, MD † City of Hope Comprehensive Vanderbilt-Ingram Cancer Center Courtney Scaife, MD ¶ Cancer Center Huntsman Cancer Institute Daniel T. Chang, MD § at the University of Utah Andrew X. Zhu, MD, PhD † Stanford Cancer Institute Massachusetts General Hospital Tracey Schefter, MD § Cancer Center University of Colorado Cancer Center Anne M. Covey, MD § Memorial Sloan Kettering Cancer Center Jason K. Sicklick, MD ¶ NCCN UC San Diego Moores Cancer Center Lauren Gallagher, RPh, PhD † Medical oncology Karin G. Hoffmann, RN, CCM § Radiotherapy/Radiation oncology/Interventional radiology Donna Powell, MS, CMD, RT(T) Continue ¶ Surgery/Surgical oncology Jillian Scavone, PhD Þ Internal medicine Sarika Trikha, PharmD ‡ Hematology/Hematology oncology NCCN Guidelines Panel Disclosures *Writing committee member Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:11:23 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 2.2015 Table of Contents Hepatobiliary Cancers Table of Contents Hepatobiliary Cancers Discussion NCCN Hepatobiliary Cancers Panel Members Clinical Trials: NCCN believes that Summary of the Guidelines Updates the best management for any cancer patient is in a clinical trial. Participation Hepatocellular Carcinoma (HCC) in clinical trials is especially • HCC Screening (HCC-1) encouraged. • Diagnosis of HCC (HCC-2) • HCC Confirmed, (HCC-4) To find clinical trials online at NCCN • Potentially Resectable or Transplantable, Operable (HCC-5) Member Institutions, click here: • Unresectable (HCC-6) nccn.org/clinical trials/physician.html. • Inoperable, Local Disease, Metastatic Disease, Extensive Liver Tumor Burden (HCC-7) • Child-Pugh Score (HCC-A) NCCN Categories of Evidence and • Principles of Surgery (HCC-B) Consensus: All recommendations • Principles of Locoregional Therapy (HCC-C) are category 2A unless otherwise Gallbladder Cancer specified. • Incidental Finding at Surgery (GALL-1) See NCCN Categories of Evidence • Incidental Finding on Pathologic Review (GALL-2) • Mass on Imaging (GALL-3) and Consensus. • Jaundice (GALL-4) • Metastatic Disease (GALL-4) • Post-Resection (GALL-5) • Principles of Surgery (GALL-A) Intrahepatic Cholangiocarcinoma • Presentation, Workup, Primary Treatment (INTRA-1) • Adjuvant Treatment, Surveillance (INTRA-2) • Principles of Surgery (INTRA-A) Extrahepatic Cholangiocarcinoma • Presentation, Workup, Primary Treatment (EXTRA-1) • Adjuvant Treatment, Surveillance (EXTRA-2) • Principles of Surgery (EXTRA-A) Staging (ST-1) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2015. Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 10/25/2015 6:11:23 AM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 2.2015 Updates Hepatobiliary Cancers Table of Contents Hepatobiliary Cancers Discussion Summary of the changes in the 2.2015 version of the Guidelines for Hepatobiliary Cancers from the 1.2015 version include: MS-1 • The discussion was updated to reflect the algorithm changes. Updates in Version 1.2015 of the NCCN Guidelines for Hepatobiliary Cancers from Version 2.2014 include: Hepatocellular Carcinoma: HCC-B Principles of Surgery HCC-1 • Sixth bullet; References added to statement: • "Screening": Reference "2" ; "Yao FY, et al. Liver transplantation for "Ultrasound (US)" and "Alfa-fetoprotein (AFP)" statements were hepatocellular carcinoma: expansion of the tumor size limits reversed. does not adversely impact survival. Hepatology 2001:33:1394- "Mass confirmed" revised: "HCC Confirmed HCC (See HCC-4 2)" 1403." added after "Patients meeting the UNOS criteria ([single • Footnote "f" was added: "There is higher-level evidence to support US lesion ≤5 cm, or 2 or 3 lesions ≤3 cm], http://www.unos.org) as a screening tool vs. AFP. See Discussion." should be considered for transplantation (cadaveric or living HCC-5 donation). More controversial are those patients whose tumor • Footnote "r" amended: "Patients with Child-Pugh Class A liver characteristics are marginally outside of the UNOS guidelines function, who fit UNOS criteria (www.unos.org) and are resectable and may be considered at some institutions for living or could be considered for resection or transplant. There is controversy deceased donor for transplantation." over which initial strategy is preferable to treat such patients. These Reference "3"; "Chapman WC, et al. Outcomes of neoadjuvant patients should be evaluated by a multidisciplinary team. transarterial chemoembolization to downstage hepatocellular See Principles of Surgery (HCC-B)" carcinoma before liver transplantation. Ann Surg 2008 HCC-6 Oct;248(4):617-25." added after "Furthermore, patients with tumor • "Not a transplant candidate"; under "Options": Bullet reading characteristics beyond Milan criteria that are down staged to "Locoregional therapy preferred" amended and moved to top. within criteria can also be considered for transplantation." • Footnote "ee" amended: "There are limited data suporting the use of HCC-C (1 of 3) Principles of Locoregional Therapy systemic chemotherapy, and its use in the context of a clinical trial is • Second bullet under "Arterially directed therapies"; acronym "RE" preferred." for "radioembolization" was added. HCC-7 • Third bullet under "Arterially directed therapies"; acronym "RE" • "Treatment"; under "Options" for "Inoperable by performance status added and radioembolization was removed. or comorbidity...": Bullet reading: "Locoregional therapy preferred" HCC-C (2 of 3) Principles of Locoregional Therapy amended and moved to top. • First bullet revised: "All tumors irrespective of the location may be amenable to EBRT (Stereotactic body radiation therapy [SBRT], intensity-modulated radiation therapy [IMRT], or 3D-conformal radiation therapy)." • Fifth bullet added: "Proton beam therapy (PBT) may be appropriate in specific situations." UPDATES Version 2.2015, 02/06/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced
Load more

Recommended publications
  • Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    International Journal of Molecular Sciences Review Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach Isabella Lurje 1,† , Zoltan Czigany 1,† , Jan Bednarsch 1, Christoph Roderburg 2,3, Peter Isfort 4, Ulf Peter Neumann 1,5 and Georg Lurje 1,* 1 Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; [email protected] (I.L.); [email protected] (Z.C.); [email protected] (J.B.); [email protected] (U.P.N.) 2 Department of Internal Medicine III, University Hospital RWTH Aachen, 52074 Aachen, Germany; [email protected] 3 Department of Gastroenterology/Hepatology, Campus Virchow Klinikum and Charité Mitte, Charité University Medicine Berlin, 13353 Berlin, Germany 4 Department for Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074 Aachen, Germany; [email protected] 5 Department of Surgery, Maastricht University Medical Centre (MUMC), 6229 ET Maastricht, The Netherlands * Correspondence: [email protected] † Both authors contributed equally to this work. Received: 9 March 2019; Accepted: 21 March 2019; Published: 22 March 2019 Abstract: Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and its mortality is third among all solid tumors, behind carcinomas of the lung and the colon. Despite continuous advancements in the management of this disease, the prognosis for HCC remains inferior compared to other tumor entities. While orthotopic liver transplantation (OLT) and surgical resection are the only two curative treatment options, OLT remains the best treatment strategy as it not only removes the tumor but cures the underlying liver disease. As the applicability of OLT is nowadays limited by organ shortage, major liver resections—even in patients with underlying chronic liver disease—are adopted increasingly into clinical practice.
    [Show full text]
  • Colon Metastasis from Recurrent Gallbladder Cancer: a Case Report
    6 Case Report Page 1 of 6 Colon metastasis from recurrent gallbladder cancer: a case report Carlo Signorelli1^, Eleonora Marrucci1, Emanuela Cristi2, Alfredo Pastorelli3, Paolo Cardello4, Mario Giovanni Chilelli1, Costantino Zampaletta3, Enzo Maria Ruggeri1 1Medical Oncology Unit, Belcolle Hospital, ASL Viterbo, Viterbo, Italy; 2Pathology Unit, Belcolle Hospital, ASL Viterbo, Viterbo, Italy; 3Gastroenterology Unit, Belcolle Hospital, ASL Viterbo, Viterbo, Italy; 4Radiology Unit, Belcolle Hospital, ASL Viterbo, Viterbo, Italy Correspondence to: Carlo Signorelli. Oncology and Haematology Department, Medical Oncology Unit, Belcolle Hospital, ASL Viterbo, Strada Sammartinese snc, Viterbo 01100, Italy. Email: [email protected]. Abstract: Gallbladder cancer (GBC) is associated with a poor prognosis. Colonic metastases representing approximately 1% of total colorectal cancers, are very rarely reported. According to more recent data in the literature, cases of colon metastases from GBC have not been reported. We report the case of a 78-year-old woman who underwent a cholecystectomy in 2017, for a diffuse carcinoma in situ and an infiltrating adenocarcinoma pT2a G2; she completed six months of adjuvant gemcitabine chemotherapy and started a regular follow up in our institution. Three years later she came to our observation after having developed severe anemia and she was diagnosed synchronous liver and colonic metastases from GBC immunohistologically confirmed. The case was collegially evaluated by a multidisciplinary team. In consideration of the progressive deterioration of the clinical conditions, the extension of the primary GBC and the patient’s age, it was decided to start in July 2020 a first-line mono-chemotherapy treatment with gemcitabine. This is probably the first reported case of colonic metastasis in a patient with a recurrent GBC with synchronous liver involvement.
    [Show full text]
  • Transarterial Chemoembolization with Radiofrequency Ablation Versus Hepatectomy in Hepatocellular Carcinoma Beyond the Milan Criteria: a Retrospective Study
    Journal name: Cancer Management and Research Article Designation: Original Research Year: 2018 Volume: 10 Cancer Management and Research Dovepress Running head verso: Yuan et al Running head recto: TACE with RFA versus hepatectomy for HCC open access to scientific and medical research DOI: http://dx.doi.org/10.2147/CMAR.S182914 Open Access Full Text Article ORIGINAL RESEARCH Transarterial chemoembolization with radiofrequency ablation versus hepatectomy in hepatocellular carcinoma beyond the Milan criteria: a retrospective study Hang Yuan* Purpose: To compare the efficacies of transarterial chemoembolization (TACE) combined Ping Cao* with radiofrequency ablation (RFA) with hepatectomy. Prognostic factors for the patient groups Hai-Liang Li were analyzed. Hong-Tao Hu Patients and methods: Data of 314 newly diagnosed cases of hepatocellular carcinoma Chen-Yang Guo beyond the Milan criteria were studied from January 2012 to December 2013 in our hospital. Forty-four patients were excluded owing to loss to follow-up (27 cases) or missing imaging Yan Zhao data (17 cases); finally, 270 patients were included. All patients underwent TACE combined Quan-Jun Yao with RFA (TR group, 136 patients) or hepatectomy (HT group, 134 patients). Efficacy evalu- Xiang Geng ation and prognostic factor analysis of the groups were conducted. Overall survival (OS) rate, Minimally Invasive and Interventional progression-free survival (PFS) rate, and major complications were recorded. Department, Affiliated Cancer The 1-, 2-, 3-, and 5-year OS rates and median survival times were 98.5%, 83.1%, Hospital of Zhengzhou University, Results: Henan Cancer Hospital, Zhengzhou 66.2%, 37.1%, and 46 months, respectively, for the TR group and 89.6%, 69.4%, 53.7%, 450008, China 30.3%, and 38 months, respectively, for the HT group.
    [Show full text]
  • Gallbladder Cancer
    Form: D-5137 Quick Facts About Gallbladder Cancer What is the gallbladder? The gallbladder is a small, pear-shaped organ located under right side of the liver. The gallbladder concentrates and stores bile, a fluid produced in the liver. Bile helps digest fats in food as they pass through the small intestine. Although the gallbladder is helpful, most people live normal lives after having their gallbladder removed. What is gallbladder cancer? Gallbladder cancer starts when normal gallbladder cells become abnormal and start to grow out of control. This can form a mass of cells called a tumour. At first, the cells are precancerous, meaning they are abnormal but are not yet cancerous. If the precancerous cells change into cancerous or malignant cells, and/or spread to other areas of the body, this is called gallbladder cancer. The most common type of gallbladder cancer is adenocarcinoma. Gallbladder adenocarcinoma is a cancer that starts in cells that line the inside of the gallbladder. What are the common symptoms of gallbladder cancer? • Abdomen pain • Nausea or vomiting • Jaundice (yellow skin) • Larger gallbladder • Loss of appetite • Weight loss • Swollen abdomen area • Severe itching • Black tarry stool What does stage mean? Once a diagnosis of cancer has been made, the cancer will be given a stage, such as: • where the cancer is located • if or where it has spread • if it is affecting other organs in the body (like the liver) 2 There are 5 stages for gallbladder cancer: Stage 0: There is no sign of cancer in the gallbladder. Stage 1: Cancer has formed and the tumour has spread to a layer of tissue with blood vessels or to the muscle layer, but not outside of the gallbladder.
    [Show full text]
  • Time to Transplantation As Predictor of Hepatocellular Recurrence After Liver Transplantation: a Retrospective Cohort Study
    ARTÍCULO ORIGINAL Estudio retrospectivo Time to transplantation as predictor of hepatocellular recurrence after liver transplantation: a retrospective cohort study Santiago Rodriguez1, Lucas Ernani 2, Alfeu de Medeiros Fleck Jr.3 Claudio Augusto Marroni1,3, Ajacio Bandeira de Mello Brandão1,3 Este artículo está bajo una licencia de Creative Commons de tipo Recono- cimiento – No comercial – Sin obras derivadas 4.0 International 1 Graduate Program in Medicine: Hepatology. Univer- sidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil. Abstract 2 Department of Gastroenterology. Digestive System Surgery, School of Medicine, Hospital das Clínicas, Hepatocellular recurrence after liver transplantation (LTx) is a major cause Universidade de São Paulo (USP), São Paulo, SP, Brasil. 3 Liver Transplantation Group, Santa Casa de Miseri- of morbidity and mortality. We aimed to investigate the association córdia de Porto Alegre, Porto Alegre, RS, Brazil. between waiting time and hepatocellular carcinoma (HCC) recurrence in patients undergoing LTx for HCC. We studied 250 patients who ORCID ID: underwent LTx between 2007-2015. Survival and recurrence curves were Santiago Rodríguez. http://orcid.org/0000-0001-8610-3622 calculated according to the Kaplan–Meier method and compared by Lucas Ernani the log-rank test. Univariate hazard ratios for predictors of post-LTx HCC https://orcid.org/0000-0001-6570-8702 Claudio Augusto Marroni recurrence were determined by Cox proportional hazards regressions. https://orcid.org/0000-0002-1718-6548
    [Show full text]
  • Gallbladder Cancer in the 21St Century
    Hindawi Publishing Corporation Journal of Oncology Volume 2015, Article ID 967472, 26 pages http://dx.doi.org/10.1155/2015/967472 Review Article Gallbladder Cancer in the 21st Century Rani Kanthan,1 Jenna-Lynn Senger,2 Shahid Ahmed,3 and Selliah Chandra Kanthan4 1 Department of Pathology & Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8 2Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7 3Division of Medical Oncology, Division of Medical Oncology, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8 4Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8 Correspondence should be addressed to Rani Kanthan; [email protected] Received 13 June 2015; Revised 7 August 2015; Accepted 12 August 2015 Academic Editor: Massimo Aglietta Copyright © 2015 Rani Kanthan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gallbladder cancer (GBC) is an uncommon disease in the majority of the world despite being the most common and aggressive malignancy of the biliary tree. Early diagnosis is essential for improved prognosis; however, indolent and nonspecific clinical presentations with a paucity of pathognomonic/predictive radiological features often preclude accurate identification of GBC at an early stage. As such, GBC remains a highly lethal disease, with only 10% of all patients presenting at a stage amenable to surgical resection. Among this select population, continued improvements in survival during the 21st century are attributable to aggressive radical surgery with improved surgical techniques. This paper reviews the current available literature of the 21st century on PubMed and Medline to provide a detailed summary of the epidemiology and risk factors, pathogenesis, clinical presentation, radiology, pathology, management, and prognosis of GBC.
    [Show full text]
  • Laparoscopic Resection of Hepatocellular Carcinoma: When, Why, and How? a Single-Center Experience
    JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 24, Number 4, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2013.0502 Laparoscopic Resection of Hepatocellular Carcinoma: When, Why, and How? A Single-Center Experience Paulo Herman, MD, Marcos Vinicius Perini, MD, Fabricio Ferreira Coelho, MD, Jaime Arthur Pirolla Kruger, MD, Renato Micelli Lupinacci, MD, Gilton Marques Fonseca, MD, Felipe de Lucena Moreira Lopes, MD, and Ivan Cecconello, MD Abstract Purpose: The aim of this study was to evaluate short- and intermediate-term results of laparoscopic liver resection in selected patients with hepatocellular carcinoma (HCC). Patients and Methods: Eighty-five patients with HCC were subjected to liver resection between February 2007 and January 2013. From these, 30 (35.2%) were subjected to laparoscopic liver resection and were retro- spectively analyzed. Special emphasis was given to the indication criteria and to surgical results. Results: There were 21 males and 9 females with a mean age of 57.4 years. Patients were subjected to 10 nonanatomic and 20 anatomic resections. Two patients were subjected to hand-assisted procedures (right posterior sectionectomies); all other patients were subjected to totally laparoscopic procedures. Conversion to open surgery was necessary in 4 patients (13.3%). Postoperative complications were observed in 12 patients (40%), and the mortality rate was 3.3%. Mean overall survival was 29.8 months, with 3-year overall and disease-free survival rates of 76% and 58%, respectively. Conclusions: Laparoscopic treatment of selected patients with HCC is safe and feasible and can lead to good short- and intermediate-term results. Introduction organ needs.
    [Show full text]
  • Risk of Colorectal Cancer and Other Cancers in Patients with Gall Stones
    Gut 1996; 39:439-443 439 Risk of colorectal cancer and other cancers in patients with gall stones Gut: first published as 10.1136/gut.39.3.439 on 1 September 1996. Downloaded from C Johansen, Wong-Ho Chow, T J0rgensen, L Mellemkjaer, G Engholm, J H Olsen Abstract Although the relation between cholecystec- Background-The occurrence of gall tomy and colorectal cancer has been con- stones has repeatedly been associated with sidered in many studies, the results are equi- an increased risk for cancer of the colon, vocal"; most of the case-control studies but risk associated with cholecystectomy showed a positive relation, but only the two remains unclear. largest cohort studies showed significantly Aims-To evaluate the hypothesis in a increased risks, which were restricted to nationwide cohort ofmore than 40 000 gall women and to the proximal part of the stone patients with complete follow up colon.'4 15 including information of cholecystectomy These results suggest that gall stones, and and obesity. possibly cholecystectomy, which are done Patients-In the population based study mainly as a result ofgall stones increase the risk described here, 42098 patients with gall for colon cancer, particularly among women stones in 1977-1989 were identified in the and in the proximal part of the colon. One Danish Hospital Discharge Register. hypothesis is that post-cholecystectomy Methods-These patients were linked to changes in the composition and secretion of the Danish Cancer Registry to assess their bile salts affect enterohepatic circulation and risks for colorectal and other cancers exposure of the colon to bile acids,'6 '` which during follow up to the end of 1992.
    [Show full text]
  • Modern Perspectives on Factors Predisposing to the Development of Gallbladder Cancer
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector DOI:10.1111/hpb.12046 HPB REVIEW ARTICLE Modern perspectives on factors predisposing to the development of gallbladder cancer Charles H. C. Pilgrim, Ryan T. Groeschl, Kathleen K. Christians & T. Clark Gamblin Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA Abstract Background: Gallbladder cancer (GBC) is a rare malignancy, yet certain groups are at higher risk. Knowledge of predisposing factors may facilitate earlier diagnosis by enabling targeted investigations into otherwise non-specific presenting signs and symptoms. Detecting GBC in its initial stages offers patients their best chance of cure. Methods: PubMed was searched for recent articles (2008–2012) on the topic of risk factors for GBC. Of 1490 initial entries, 32 manuscripts reporting on risk factors for GBC were included in this review. Results: New molecular perspectives on cholesterol cycling, hormonal factors and bacterial infection provide fresh insights into the established risk factors of gallstones, female gender and geographic locality. The significance of polyps in predisposing to GBC is probably overstated given the known dysplasia–carcinoma and adenoma–carcinoma sequences active in this disease. Bacteria such as Sal- monella species may contribute to regional variations in disease prevalence and might represent powerful targets of therapy to reduce incidences in high-risk areas. Traditional risk factors such as porcelain gallbladder, Mirizzi's syndrome and bile reflux remain important as predisposing factors. Conclusions: Subcentimetre gallbladder polyps rarely become cancerous. Because gallbladder wall thickening is often the first sign of malignancy, all gallbladder imaging should be scrutinized carefully for this feature.
    [Show full text]
  • Continuous Improvement of Survival Outcomes of Resection of Hepatocellular Carcinoma: a 20-Year Experience
    Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience (ANNSURG-D-10-00234.R2) Sheung Tat FAN MS, MD, PhD, DSc, FRCS (Glasg & Edin), FACS Chung Mau LO MS, FRCS (Edin), FACS Ronnie T.P. POON MS, PhD, FRCS (Edin), FACS Chun YEUNG MBBS, FRCS (Glasg), FACS Chi Leung LIU MBBS, MS, MD, FRCS (Edin), FACS Wai Key YUEN MBBS, FRCS (Glasg), FRACS (Gen Surg), FACS Chi Ming LAM MBBS, MS, PhD, FRCS (Edin) Kelvin K.C. NG MS, PhD, FRCSEd (Gen) See Ching CHAN MS, FRCS (Edin) Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam Road, Hong Kong Correspondence to: Professor Sheung Tat FAN Department of Surgery The University of Hong Kong Queen Mary Hospital 102 Pok Fu Lam Road Hong Kong Tel: (852) 2255 4703 Fax: (852) 2986 5262 Email: [email protected] Keywords: Hepatocellular carcinoma, hepatectomy, hospital mortality, survival rates Short title: Survival outcomes of resection of hepatocellular carcinoma Mini-Abstract A continuous improvement of the survival results of hepatectomy for hepatocellular carcinoma was observed in the past 20 years. The improvement was seen in patients with cirrhosis, those undergoing major hepatectomy, and those with liver tumors of TNM stages II, IIIA and IVA. Structured Abstract Objective: To investigate the trend of the post-hepatectomy survival outcomes of hepatocellular carcinoma (HCC) patients by analysis of a prospective cohort of 1198 patients over a 20-year period. Summary Background Data: The hospital mortality rate of hepatectomy for HCC has improved but the long-term survival rate remains unsatisfactory.
    [Show full text]
  • Incidental Carcinoma After Cholecystectomy for Benign Disease of the Gallbladder: a Meta-Analysis
    Journal of Clinical Medicine Article Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis Jung-Soo Pyo 1 , Byoung Kwan Son 2,* , Hyo Young Lee 2, Il Whan Oh 2 and Kwang Hyun Chung 2 1 Department of Pathology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea; [email protected] 2 Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul 01830, Korea; [email protected] (H.Y.L.); [email protected] (I.W.O.); [email protected] (K.H.C.) * Correspondence: [email protected]; Tel.: +82-2-970-8204; Fax: +82-2-970-8621 Received: 23 April 2020; Accepted: 11 May 2020; Published: 14 May 2020 Abstract: This study aimed to determine the incidence and the prognosis of incidental carcinoma of the gallbladder (IGBC) after cholecystectomy through a meta-analysis. This meta-analysis included 51 studies and 436,636 patients with cholecystectomy. The incidence rate of IGBC after cholecystectomy was 0.6% (95% confidence interval (CI) 0.5–0.8%). The incidence rate of recent studies was not significantly different from those of past studies. The mean age and female ratio of the IGBC subgroup were not significantly different from those of the overall patient group. The estimated rates of IGBC were 13.0%, 34.1%, 39.7%, 22.7%, and 12.5% in the pTis, pT1, pT2, pT3, and pT4 stages, respectively. Patients with IGBC had a favorable overall survival rate compared to patients with non-IGBC (hazard ratio (HR) 0.574, 95% CI 0.445–0.739).
    [Show full text]
  • The Spectrum of Gallbladder Disease
    The Spectrum of Gallbladder Disease Rebecca Kowalski, M.D. October 18, 2017 Overview A (brief) history of gallbladder surgery Anatomy Anatomical variations Physiology Pathophysiology Diagnostic imaging of the gallbladder Natural history of cholelithiasis Case presentations of the spectrum of gallstone disease Summary History of Gallbladder Surgery Gallbladder Surgery: A Relatively Recent Change Prior to the late 1800s, doctors treated gallbladder disease with a cholecystostomy, due to the fear that removing the organ would kill patients Carl Johann August Langenbuch (director of the Lazarus Hospital in Berlin, Germany) practiced on a cadaver to remove the gallbladder, and in 1882, performed a cholecystectomy on a patient. He was discharged after 6 weeks in the hospital https://en.wikipedia.org/wiki/Carl_Langenbuch By 1897 over 100 cholecystectomies had been performed Gallbladder Surgery: A Relatively Recent Change In 1985, Erich Mühe removed a patient’s gallbladder laparoscopically in Germany Erich Muhe https://openi.nlm.ni h.gov/detailedresult. php?img=PMC30152 In 1987, Philippe Mouret (a 44_jsls-2-4-341- French gynecologic surgeon) g01&req=4 performed a laparoscopic cholecystectomy In 1992, the National Institutes of Health (NIH) created guidelines for laparoscopic cholecystectomy in the United Philippe Mouret States, essentially transforming https://www.pinterest.com surgical practice /pin/58195020154734720/ Anatomy and Abnormal Anatomy http://accesssurgery.mhmedical.com/content.aspx?bookid=1202&sectionid=71521210 http://www.slideshare.net/pryce27/rsna-final-2 http://www.slideshare.net/pryce27/rsna-final-2 http://www.slideshare.net/pryce27/rsna-final-2 Physiology a http://www.nature.com/nrm/journal/v2/n9/fig_tab/nrm0901_657a_F3.html Simplified overview of the bile acid biosynthesis pathway derived from cholesterol Lisa D.
    [Show full text]