Prognostic Impact of Resection Margin Length in Patients Undergoing Resection for Mid-Common Bile Duct Cancer: A Single-Center Experience

2021 ◽  
pp. 1-10
Author(s):  
Yo-Han Park ◽  
Sang Hyuk Seo ◽  
Min Sung An ◽  
HyungJoo Baik ◽  
Chan Ho Lee
Keyword(s):  
Bile Duct ◽  
Bile Duct Cancer ◽  
Resection Margin ◽  
R0 Resection ◽  
Cutoff Value ◽  
Common Bile Duct Cancer ◽  
Duct Cancer ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

<b><i>Introduction:</i></b> The purpose of this study was to analyze survival outcomes after segmental bile duct resection (BDR) for mid-common bile duct cancer according to the length of the tumor-free BDR margins. <b><i>Method:</i></b> A total of 133 consecutive patients underwent BDR for mid-bile duct cancers between December 2007 and June 2017. The Cox proportional hazard model was used to verify the cutoff value of the R0 resection margin. The patients were divided into 3 groups according to resection margin status (group 1; R0 resection margin ≥5 mm; group 2, R0 resection margin &#x3c;5 mm; and group 3, R1 resection margin). <b><i>Results:</i></b> The median follow-up period of the study cohort was 24 months. A resection margin of 5 mm in length was verified to be suitable as a reliable cutoff value. The median disease-free and overall survival (OS) periods were 32 and 49 months in group 1, 13 and 20 months in group 2, and 23 and 30 months in group 3, respectively (<i>p</i> = 0.03 and <i>p</i> &#x3c; 0.001). The length of the tumor-free resection margin (hazard ratio, 2.01; 95% confidence interval, 1.10–3.67; <i>p</i> = 0.022) was independent factor affecting OS. <b><i>Conclusions:</i></b> BDR for mid-bile duct cancer appears to be a feasible surgical option in selected patients with careful preoperative imaging assessment and intraoperative frozen-section diagnosis. Our results suggest achieving a BDR margin ≥5 mm to improve survival outcomes.

Abstract 14551: Biomarkers Predicting the Treatment-Resistant Kawasaki Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yukako Yoshikane ◽  
Ryuji Fukazawa ◽  
Kyoko Imanaka-yoshida ◽  
Naho Kobayashi ◽  
Yasuhiro Katsube
Keyword(s):  
Treatment Group ◽  
Kawasaki Disease ◽  
Predictive Value ◽  
Scoring Systems ◽  
Line Treatment ◽  
Treatment Resistant ◽  
Cutoff Value ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Introduction: Kawasaki disease (KD), which is the most common multisystem vasculitis with unknown causes in childhood, causes coronary artery lesions (CALs). Treatment with a high dose of intravenous immunoglobulin (IVIG), plus steroids if needed, is the most effective therapy for the acute phase of KD. However, there are some very severe cases who need several times additional treatments and are at risk for CALs. In Japan, there are some scoring systems that initially predict IVIG-resistant patients. However, the problem is that these scoring systems fail in multiethnic populations. The aim of this study is to find universal biomarkers that predict treatment-resistant cases of KD. Methods: The subject was 276 KD patients, including Group 1 (n=214) who needed only 1 st line treatment, Group 2 (n=48) who needed 2 nd line treatment, Group 3 (n=14) who needed 3 rd line treatment or more. Tenascin C (TN-C), Pentraxin 3 (PTX3) and Procalcitonin (PCT) values, which were selected by systematic review, were measured before initial treatment in each group. Results: TN-C; 99.8±41.05 ng/ml in Group 1, 118.0±71.4 ng/ml in Group 2 and 183.0±25.0 ng/ml in Group 3. The TN-C level of Group 3 was significantly higher than that of all the others (p<0.01). The cutoff value for distinguishing Group 3 was 142.0 ng/ml (Area under the Curve (AUC)=0.81). PTX3; 16.2±9.0 ng/ml in Group 1, 31.4±19.7 ng/ml in Group 2 and 58.0±33.0 ng/ml in Group 3. The PTX3 level of Group 3 was significantly higher than that of all the others (p<0.01). The cutoff value for distinguishing Group 3 was 35.1 ng/ml (AUC=0.86). PCT; 0.79±0.77 ng/ml in Group 1, 2.55±3.01 ng/ml in Group 2 and 4.15±4.49 ng/ml in Group 3. The PCT level of Group 3 was significantly higher than that of all the others (p<0.01). The cutoff value for distinguishing Group 3 was 2.55 ng/ml (AUC=0.88). When those three biomarkers combined, Group 3 can be predicted with the sensitivity 79%, the specificity 96%, the positive predictive value 50% and the negative predictive value 99%. Conclusions: It may be possible to predict treatment-resistant KD cases with high sensitivity and specificity by combining the measurement from the universal biomarkers, TN-C, PTX3 and PCT, before initial treatment.

Multimicrobial Sepsis Including Clostridium perfringens  after Chemoembolization of a Single Liver Metastasis from Common Bile Duct Cancer

Digestion ◽  
2000 ◽  
Vol 62 (2-3) ◽  
pp. 208-212 ◽  
Author(s):  
Florian Eckel ◽  
Christian Lersch ◽  
Wolfgang Huber ◽  
Wolfgang Weiss ◽  
Hermann Berger ◽  
...  
Keyword(s):  
Bile Duct ◽  
Liver Metastasis ◽  
Common Bile Duct ◽  
Clostridium Perfringens ◽  
Bile Duct Cancer ◽  
Common Bile Duct Cancer ◽  
Duct Cancer

scholarly journals The Effects of Bile Duct Obstruction on Liver Volume: An Experimental Study

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Bahtiyar Ertor ◽  
Serdar Topaloglu ◽  
Adnan Calik ◽  
Umit Cobanoglu ◽  
Ali Ahmetoglu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Obstructive Jaundice ◽  
Liver Volume ◽  
Control Group ◽  
Group 4 ◽  
Duct Ligation ◽  
Group 3 ◽  
Baseline Values ◽  
Group 2 ◽  
Group 1

Objectives. This study is aimed at investigating alterations in liver volume during obstructive jaundice in rat liver. Materials and Methods. Thirty-six rats were divided into four groups. Abdominal tomography was performed for baseline volumetric analyses. The main bile ducts were ligated (BDL). Volumetric analyses were repeated 3 days after BDL in group 1, 7 days after BDL in group 2, 15 days after BDL in group 3, and 25 days after BDL in group 4, and total hepatectomy was performed in all animals. Control group () was created with the rats that died before bile duct ligation. Results. There was no difference found in liver volume in group 1 compared to control animals. The liver volume was increased 7 days after BDL (). It was increased up to 60% of baseline values 25 days after BDL (). Wet liver weights of animals were also increased compared to control group. Liver weights were increased up to 40% percent of baseline values in group 4 (). Conclusions. Liver volume and weight were increased after BDL. Liver surgery in patients with huge liver mass is generally associated with significant difficulty. The surgeon should be aware of the time-dependent alteration in liver volume after obstructive jaundice.

Common Bile Duct Cancer with Massive Necrosis Mimicking Choledochal Dilatation on CT

1991 ◽  
Vol 32 (4) ◽  
pp. 337-338 ◽  
Author(s):  
H. Miyake ◽  
S. Matsumoto ◽  
S. Ueda ◽  
T. Maeda ◽  
H. Aikawa ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Cancer ◽  
Common Bile Duct Cancer ◽  
Massive Necrosis ◽  
Duct Cancer

Common Bile Duct Cancer with Massive Necrosis Mimicking Choledochal Dilatation on CT

1991 ◽  
Vol 32 (4) ◽  
pp. 337-338 ◽  
Author(s):  
Hidetoshi Miyake ◽  
S. Matsumoto ◽  
S. Ueda ◽  
T. Maeda ◽  
H. Aikawa ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Cancer ◽  
Common Bile Duct Cancer ◽  
Massive Necrosis ◽  
Duct Cancer

Intraductal papillary neoplasm of the bile duct (IPNB): A biliary equivalent to IPMN of the pancreas?

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 201-201
Author(s):  
F. G. Rocha ◽  
H. Lee ◽  
N. Katabi ◽  
R. P. DeMatteo ◽  
Y. Fong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Median Survival ◽  
Survival Data ◽  
Bile Duct Cancer ◽  
Clinicopathological Parameters ◽  
R0 Resection ◽  
Depth Of Invasion ◽  
Intraductal Papillary Neoplasm ◽  
Duct Cancer ◽  
Papillary Neoplasm

201 Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a type of cholangiocarcinoma characterized by intraductal growth, mucin production and a better outcome compared to the more common nodular-sclerosing type. IPNB may be analogous to IPMN of the pancreas and may be a precursor of invasive cholangiocarcinoma, but its pathogenesis and natural history are ill-defined. This study examines the incidence, clinicopathologic features and outcome of IPNB in a single center. Methods: A consecutive cohort of patients with bile duct cancer (hilar, intrahepatic or distal) was reviewed and those with papillary features identified. Histopathologic morphology and immunohistochemical staining for cytokeratin and mucin proteins were utilized to classify IPNB into subtypes. Survival data were analyzed and correlated with clinicopathological parameters. Results: Between 1993 and 2008, 40 IPNBs were identified in hilar (24/144), intrahepatic (4/86) and distal (12/113) bile duct cancer specimens (11.7%). Histopathologic examination revealed 27 pancreatobiliary, 4 gastric, 3 intestinal, and 6 oncocytic subtypes; cytokeratin and mucin staining was similar to that of IPMNs of the pancreas. Invasive carcinoma was seen in 29/40 (72%) IPNBs. Overall median survival was 59 months and was not different between IPNB locations or subtypes. Factors associated with a worse median survival included depth of invasion (39 months for > 5mm, 128 months for < 5mm, and 144 months for none, p <0.05), R1 vs R0 resection (36 months vs 82 months, p <0.05), MUC1 expression (53 months for positive vs 144 months for negative, p <0.006), and CEA expression (42 months for positive vs 128 for negative, p<0.02). Expression of MUC2, MUC5A, MUC6, CDX2, mesothelin, p53, Ki67, HepPar1, and B72.3 were not predictive of outcome. Conclusions: IPNBs are an uncommon variant of bile duct cancer, representing approximately 10% of all cases, occur throughout the biliary tract and share histologic and clinical features with IPMNs of the pancreas. These lesions may represent an alternative carcinogenesis pathway. Given their significant malignant potential, they should be treated aggressively with margin-negative resection. No significant financial relationships to disclose.

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