Intraductal Papillary Neoplasm of the Bile Ducts: Case Reports with Review of the Literature

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors, which is a counterpart of pancreatic intraductal papillary mucinous neoplasm (IPMN). These tumors need to be differentiated from other common bile duct tumors such as cholangiocarcinoma, as IPNB carries a better prognosis. A combination of enhancing intraluminal papillary filling defect, demonstrating washout and associated upstream and downstream biliary dilation, should raise the suspicion of IPNB.

First experience of intraductal photodynamic Klatskin tumor therapy by using SpyGlass ™ DS technology in Russia

The bile duct tumors diagnostics is very challenging due to the long asymptomatic course of the disease, complexity of early diagnosis and morphological verification of oncological process. In the vast majority of cases, the development of obstructive jaundice and the absence of pain syndrome are the only reasons that make it possible to suspect intraductal cholangiocarcinoma. CT, MRI and US examinations make it possible to suspect the localization of the tumor process in proximal regions and confluence of bile ducts. Morphological confirmation of the diagnosis can be obtained by performing a blind biopsy during ERCP and by performing intraoperative or oral cholangioscopy. The results of Klatskin tumor surgical treatment are unsatisfactory and tend to have high mortality rates. Chemotherapy and radiotherapy also do not meet the modern requirements of treatment. Oral cholangioscopy makes it possible to differentiate genesis of extrahepatic bile duct strictures with high accuracy, to perform targeted biopsy and to conduct a photodynamic therapy, which has shown high efficiency according to foreign studies. It the first time in Russia the authors have applied photodynamic therapy method using digital video choledochoscope of SpyGlass™ DS technology to treat a patient with Klatskin tumor.

Tuberculosis de la vía biliar

Biliary TBC is a rare entity, possibly underdiagnosed and is, therefore, a diagnostic and therapeutic challenge today, due to the increase in its incidence in the population. There are no pathognomonic characteristics of imaging diagnosis of biliary TBC; for this reason, it is obtained by histopathological study of the piece. We present the clinical case of a 29-year-old female patient who consults for progressive jaundice, choluria, and pruritus. As the only antecedent of hierarchy, she is the veterinary of large animals. The patient is studied with laboratory, ultrasound and magnetic resonance, with suspected bile duct tumors. Surgical behavior is decided with gallbladder and bile duct resection and biliodigestive anastomosis with pathological anatomy and PCR (C-reactive protein) that reports TBC of the bile duct.

Preliminary results of robotic pancreaticoduodenectomy at hepatobiliary-pancreatic surgery department – Cho Ray Hospital

Tóm tắt Đặt vấn đề: Cắt khối tá tụy là một trong những phẫu thuật ổ bụng khó nhất. Việc áp dụng phương pháp xâm lấn tối thiểu cho phẫu thuật này gặp nhiều khó khăn với dụng cụ nội soi cổ điển. Phẫu thuật nội soi với robot hỗ trợ giúp phẫu thuật trở nên dễ dàng hơn. Mục tiêu: Đánh giá kết quả sớm phẫu thuật robot cắt khối tá tụy Phương pháp nghiên cứu: Mô tả tiền cứu các trường hợp cắt khối tá tụy bằng robot tại khoa Ngoại gan mật tụy bệnh viện Chợ Rẫy Kết quả: Trong thời gian tháng 12/2017 đến tháng 3/2019, chúng tôi đã thực hiện 28 trường hợp cắt khối tá tụy bằng robot. Chẩn đoán trước mổ đa số là u bóng Vater (77%), u đoạn cuối ống mật chủ và u đầu tụy lần lượt chiếm 9% và 14%. Thời gian phẫu thuật trung bình là 522,5 phút. Chuyển mổ mở 2 trường hợp (7,1%). Điểm đau trung bình các ngày hậu phẫu theo VAS là 4. Có 6 trường hợp biến chứng nhẹ (Clavien-Dindo độ 1-2, 21,4%), 4 trường hợp biến chứng nặng (Clavien-Dindo độ 3-4, 14,3%), mổ lại 2 trường hợp (7,1%). Không có tử vong. Thời gian hậu phẫu trung bình là 16,4 ngày. Kết luận: Kết quả của nghiên cứu tương đồng với kết quả của các tác giả trên thế giới. Phẫu thuật robot cắt khối tá tụy được chứng minh là an toàn và khả thi. Abstract Introduction: Pancreaticoduodenectomy is one of most challenge of abdominal procedures. Application of minimal invasive surgery in this procedure encounters many difficulties with classic laparoscopic instruments. Robot- assisted surgery system refers minimal invasive surgery in pancreaticoduodenectomy easier. Material and Methods: Assess the preliminary results of robotic pancreaticoduodenectomy Results: From December 2017 to March 2019, we performed 28 cases of robotic pancreaticoduodenectomy. Preoperative diagnosis includes authors Vater tumors (77%), distal bile duct tumors (9%) and pancreatic head tumor (14%). Mean operative time was 522,5 minutes. Conversion rate was 7,1% (n=2). Average mean postoperative VAS score was 4. There was 6 cases of mild complications (Clavien-Dindo grade 1-2, 21,4%), 4 cases of severe complications (Clavien-Dindo grade 3-4, 14,3%), Reoperation in 2 cases (7,1%). No case of death was observed. Mean postoperative hospital stay were 16,4 days. Conclusion: Our results are similar to other authors in worldwide so we suggested that robotic pancreaticoduodenectomy was proved to be safe and feasible. Keywords: Laparoscopic D.P.C, Robotic surgery

Stereotactic Ablative Radiotherapy for Patients with Unresectable or Medically Inoperable Cholangiocarcinoma

Purpose The role of stereotactic ablative radiotherapy (SABR) in patients with unresectable or medically inoperable cholangiocarcinoma remains unclear. We examined the efficacy and safety of SABR in this group of patients. Methods From January 2008 to December 2014, 15 patients with 17 lesions were included in this study. The lesions included 14 intrahepatic, 1 hilar, and 2 distal bile duct tumors. Three patients were classified as medically inoperable because of old age or multiple comorbidities. Tumors measured 0.8-13 cm (median, 3.6 cm). The median prescribed dose was 45 Gy delivered in 5 fractions over 5 consecutive days. Results The median follow-up period for surviving patients was 29.9 months. Objective responses were observed for 10 of 17 tumors (58.8%), including 3 complete responses (17.6%). The median survival duration was 12.6 months, and the 1- and 2-year overall survival rates were 50.3% and 14.4%, respectively. The 1- and 2-year in-field failure-free rates were 61.5% and 30.8%, respectively. For patients with biologically effective doses (BEDs) exceeding 75 Gy10, the 1- and 2-year overall survival rates were 58.3% and 33.3%, respectively, compared to 20.0% and 0%, respectively for those with BEDs lower than 75 Gy10. Radiation-induced liver disease did not develop in any patient. Acute toxicities were generally mild and tolerable. Conclusions Stereotactic ablative radiotherapy could be an alternative treatment for unresectable or medically inoperable cholangiocarcinoma. Further dose escalation may be considered to optimize local control.