• Surgical treatment of hilar cholangiocarcinoma (Klatskin tumor)--analysis of the curative strategies.

• The association of oral contraception with kidney cancer, colon cancer, gallbladder cancer (including extrahepatic bile duct cancer) and

• Studies on biliary tract carcinoma in the case with pancreaticobiliary maljunction.

• New reconstructive surgery of remnant pancreas in cases of cancer of Vater's papilla.

• Primary carcinoma of the gall bladder: a review of our experience.

• [Clinical application of extended resection of Vater's papilla]

• [Current topics of surgical treatments for advanced gallbladder carcinoma. I. Introduction]

• [Surgical treatment for advanced gallbladder cancer: indications and limitations]

• [S4 S5 subsegmentectomy of the liver for gallbladder carcinoma]

• [Indication and operative techniques of extended right hepatic lobectomy for advanced gallbladder cancer]

• [Significance of aggressive lymph node dissection in advanced gallbladder carcinoma]

• [Significance of resecting the head of the pancreas for the treatment of gallbladder cancer from the perspective of surgical results and mode of

• [Postoperative complications and management in the surgical treatment for advanced gallbladder carcinomas]

• Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications.

• Endoscopic sphincterotomy and pancreatic duct stent placement before endoscopic papillectomy: are they necessary and safe procedures?

• High-dose-rate remote afterloading intracavitary brachytherapy for the treatment of extrahepatic biliary duct carcinoma.

• Diagnosis of pT2 gallbladder cancer by serial examinations with endoscopic ultrasound and angiography.

• Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up.

• Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in

• Surgery for carcinoma of the gallbladder. Our experience.

• Role of postoperative radiotherapy in the management of extrahepatic bile duct cancer.

1
UI - 12211752
AU - Jaeck D; Bachellier P; Oussoultzoglou E; Weber JC; Wolf P
TI - Surgical treatment of hilar cholangiocarcinoma (Klatskin tumor)--analysis of the curative strategies.
SO - Med Sci Monit 2001 May;7 Suppl 1():64-6
AD - Centre de Chirurgie Viscerale et de Transplantation, Hopital Universitaire de Hautepierre, Strasbourg, France.

2
UI - 1868737
AU - Milne R; Vessey M
TI - The association of oral contraception with kidney cancer, colon cancer, gallbladder cancer (including extrahepatic bile duct cancer) and pituitary tumours.
SO - Contraception 1991 Jun;43(6):667-93
AD - Department of Public Health and Primary Care, Radcliffe Infirmary, Oxford, England.
This paper reviews the evidence for a relationship between oral contraceptive use and certain neoplasms: cancers of the kidney, colon and gallbladder (including the extrahepatic bile ducts) and tumours (benign or malignant) of the pituitary. Special reference is made to controlled epidemiological studies, both case-control and cohort. There is no convincing evidence that oral contraceptive use is causally related, either negatively or positively, to any of the tumours studied.

3
UI - 11941930
AU - Hara H; Morita S; Ishibashi T; Sako S; Dohi T; Otani M; Iwamoto M; Inoue
TI - H; Tanigawa N Studies on biliary tract carcinoma in the case with pancreaticobiliary maljunction.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):104-8
AD - Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. sur049@poh.osaka-med.ac.jp
BACKGROUND/AIMS: The purpose of this study was to clarify the clinicopathological features of pancreaticobiliary maljunction and to determine the appropriate surgical approach for biliary tract with pancreaticobiliary maljunction. METHODOLOGY: The data of 77 patients with pancreaticobiliary maljunction including 13, who had been treated for biliary tract cancer, were reviewed retrospectively. We assessed the clinical features, biological characteristics of the cancer, methods of surgical treatment, postoperative outcome and cell proliferating activity of the biliary epithelium, evaluated by the PCNALI (proliferating cell nuclear antigen-labeling index). RESULTS: The incidence of cancer development in the case with pancreaticobiliary maljunction was 13.4% in the bile duct dilatation group (n = 67) and 40.0% in the non-dilatation group (n = 10). Dissection of lymphadenectomy was performed in 10 (76.9%) of 13 patients, and curative resection was feasible in 9 of the 10 patients. Two (20.0%) of the 10 patients had lymph node involvement noted at surgery and died of recurrence. In the other eight patients without lymph node involvement at surgery, six patients underwent curative resection and are alive at 7 months to 11 years and 6 months after surgery. PCNALI of the biliary epithelium of the patients with pancreaticobiliary maljunction was significantly higher than that of the control group. CONCLUSIONS: For patients with pancreaticobiliary maljunction, it should be stressed that the extrahepatic bile duct be prophylactically removed, even when there are no neoplasmatic changes because of high prevalence of cancer development, presumably predicted by the increase of cell proliferative activity in the biliary epithelium. For patients with biliary cancer, early detection at the stage with no lymph node involvement is essential to secure for long-term survival.

4
UI - 11941969
AU - Arkossy P; Toth P; Kovacs I; Sapy P
TI - New reconstructive surgery of remnant pancreas in cases of cancer of Vater's papilla.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):255-7
AD - 2nd Department of Surgery, University Medical School of Debrecen, Moricz Zs. Krt. 22, 4004 Debrecen, Hungary.
BACKGROUND/AIMS: The radical surgical procedure for treatment of the carcinoma of papilla of Vater is the pancreatoduodenectomy. The mortality rate of the surgery highly decreased in the last decade, nevertheless there are complications related to the complication of anastomosis of the remnant pancreas. METHODOLOGY: The authors introduce a new reconstructional procedure to decrease the complications. After the removal of the pancreatic head and body an end-to-side anastomosis was performed between the pancreatic duct and a Roux-en jejunal loop. The second anastomosis of the procedure was an end-to-side choledochojejunostomy, the third was an end-to-side duodenojejunostomy. The duodenojejunostomy is about 40 cm from the pancreatic anastomosis, keeping food far from the pancreas with the help of peristaltic waves. This method was applied in 6 patients. RESULTS: It was found that the new reconstructional procedure had generally favorable results without complication. CONCLUSIONS: This method of reconstruction allows for spontaneous closure and safe drainage of potential insufficient pancreaticojejunostomy. The recovered patients support future favorable usage of this new reconstructional surgical procedure.

5
UI - 12236404
AU - Cunningham CC; Zibari GB; Johnston LW
TI - Primary carcinoma of the gall bladder: a review of our experience.
SO - J La State Med Soc 2002 Jul-Aug;154(4):196-9
Carcinoma of the gallbladder is a rare, but deadly, cancer of the gastrointestinal tract. A retrospective review of 29 medical records of patients with primary carcinoma of the gallbladder was performed. Twenty-eight patients (96%) were age 50 or greater at diagnosis. The most common presenting symptom was abdominal pain (82.7%), followed by nausea and vomiting (44.8%). An ultrasound of the gallbladder was the most common pre-operative study (72.4%). Seventy-one percent of ultrasounds revealed only cholelithiasis. Symptomatic cholelithiasis was the most common pre-operative diagnosis (48.2%). Laparoscopic cholecystectomy was performed in 9 (31%) patients. All patients with carcinoma in situ, stage I, and stage II disease were living at last follow up. Average survival after diagnosis for stage III disease was 5.7 months, and for stage IV disease was 3.1 months. Our results and that of others lead us to believe that in any patient with a pre-operative or intra-operative suspicion of gallbladder cancer an open procedure is indicated. Furthermore, we believe that laparoscopic cholecystectomy may be inadequate and contraindicated in all but carcinoma in situ and stage I disease.

6
UI - 11235579
AU - He C; Wu Y; Cui P
TI - [Clinical application of extended resection of Vater's papilla]
SO - Zhonghua Zhong Liu Za Zhi 2000 Nov;22(6):516-8
AD - Department of General Surgery, Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
OBJECTIVE: To report the surgical technique and clinical application of extended resection of Vater's papilla (ERVP). METHODS: ERVP was performed in 12 selected patients with tumors of ampulla of Vater according to the following criteria: (1) no signs of distant mestastasis before operation; (2) no hepatic and peritoneal mestastasis during exploration, frozen section of peripancreas-duodenal lymph nodes being negative; (3) tumor less than 2 cm in diameter, pathologic examination of tumor being adenocarcinoma or adenoma; (4) pathologic examination of edge of resection being negative. RESULTS: There was no operative death nor complications in 12 cases treated by ERVP. The average time of operation was 2.3 hours, the average amount of blood infused was 433 ml, and the average time of hospitalization was 15.8 days. In 5 of 10 cases of Vater's ampullary adenocarcinoma, the mean survival time was 42 months (36-62 months). The remaining 5 cases are still alive at 20-64 months. Two patients with Vater's ampullary adenoma still survive at 32 and 46 months, respectively. CONCLUSION: ERVP is easy to perform with comparatively less surgical trauma and complication, but redical excision of tumor is not easy. It may be particulary indicated for older and high-risk patients, or patients with cancer less than 2 cm in diameter.

7
UI - 12229153
AU - Saito K
TI - [Current topics of surgical treatments for advanced gallbladder carcinoma. I. Introduction]
SO - Nippon Geka Gakkai Zasshi 2002 Aug;103(8):537
AD - Department of Surgery I, Iwate Medical University School of Medicine, Morioka, Japan.

8
UI - 12229154
AU - Uesaka K; Hayakawa N; Kamiya J; Kondo S; Nagino M; Kanai M; Sano T; Arai
TI - T; Yuasa N; Oda K; Nishio H; Nimura Y [Surgical treatment for advanced gallbladder cancer: indications and limitations]
SO - Nippon Geka Gakkai Zasshi 2002 Aug;103(8):538-42
AD - Division of Surgical Oncology, Department of Surgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
We have aggressively performed extensive surgery including major liver resection for advanced gallbladder cancer since 1979. The 5-year survival rates for stage IVa and IVb patients after curative resection were 19% and 6%, respectively. Seven patients in the stage IVa group (n = 69) and one in stage IVb (n = 16) have survived for more than 5 years. The hospital mortality rate including all deaths within and over 30 days of curative operation for stage IV gallbladder cancer was 19%. Although radical resection is the only treatment of choice for advanced gallbladder cancer to obtain long-term survival, there are serious problems in extensive surgery. The most important issue is reduction of the hospital mortality rate. Elucidation of the clinical and molecular characteristics leading to potential long-term survival and development of new strategies for the treatment of recurrent tumors are also important issues.

9
UI - 12229155
AU - Unno M; Suzuki M; Katayose Y; Takeuchi H; Rikiyama T; Matsuno S
TI - [S4 S5 subsegmentectomy of the liver for gallbladder carcinoma]
SO - Nippon Geka Gakkai Zasshi 2002 Aug;103(8):543-8
AD - Division of the Gastroenterological Surgery, Department of Surgery, Tohoku University Graduate School of Medical Science, Sendai, Japan.
Although innovations have occurred in imaging technology and surgical techniques, carcinoma of the gall-bladder still has a poor prognosis. Since the 1960s, we have performed extended cholecystectomy in patients with gallbladder cancer. Extended cholecystectomy is a safe and common treatment for advanced cancer, but the extent of necessary hepatic resection has not been established. In 2000, we reported that the gallbladder veins infused into the intrahepatic portal venous branch, mostly at P4 and P5(96.7%). Based on those results, we now perform resection of the lower part of segment 4(S4a) and segment 5 for advanced cancer with subserosal invasion and/or negligible direct invasion to the parenchyma of the liver. S4aS5 subsegmentectomy is thought to have a clear advantage over extended surgical margins. This procedure can remove almost all the area perfused by the gallbladder veins and as a results, it may also remove latent and occult metastatic foci. The steps in the procedure are as follows: 1) lymph nodes cleaning of the posterior of the pancreas head; 2) skeletonization of the hepatoduodenal ligament; 3) identification and ligation of the lower branch of P4; 4) identification of the boundary between the anterior and posterior segment; and 5) hepatic resection with the plate of the gallbladder. Since 1991, we have performed S4aS5 subsegmentectomy in 12 patients with gallbladder cancer. Although the follow-up period is short, it is thought that the outcome of this procedure is better than that of extended cholecystectomy because of the low mortality and morbidity rates.

10
UI - 12229156
AU - Kondo S; Katoh H
TI - [Indication and operative techniques of extended right hepatic lobectomy for advanced gallbladder cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Aug;103(8):549-52
AD - Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Gallbladder cancer extends directly to the hepatic hilum and/or the right portal pedicle in the hepatic hilum type and the bed and hilum type of disease. Extended right hepatic lobectomy (ERHL), caudate lobectomy, lymph node dissection, and biliary reconstruction are necessary for radical resection of the tumor. It was previously thought that this extensive surgery carried high risk, with a hospital death rate of 20%, and had little survival benefit. However, it is now feasible with lower risk due to improvement in biliary decompression techniques, prevention of intrahepatic segmental cholangitis, introduction of preoperative portal embolization, etc. Long-term survival has been achieved after surgery unless there is hepatic, peritoneal, or paraaortic metastasis. Hilar hepatic involvement is more advanced in gallbladder cancer than in bile duct cancer, and portal vein resection and reconstruction are inevitable. All six such patients in our department over the past two years underwent concomitant portal reconstruction and have survived postoperatively.

11
UI - 12229157
AU - Tsukada K; Abe H; Bando T; Nagata T
TI - [Significance of aggressive lymph node dissection in advanced gallbladder carcinoma]
SO - Nippon Geka Gakkai Zasshi 2002 Aug;103(8):553-6
AD - Department of Surgery II, Toyama Medical and Pharmaceutical University, Toyama, Japan.
Although aggressive lymph node dissection has been performed in gallbladder carcinoma as well as in other carcinomas of the alimentary tract, there is no definitive evidence of the efficacy of extended lymph node dissection. However, extensive lymph node metastasis is well known in advanced carcinoma of the gallbladder. From the viewpoint of the balance between radicality and safety in surgery, wider lymph node dissection consisting of the lymph nodes in the hepatoduodenal ligamentum and parapancreatic area is recommended in selected patients who hare no involvement of the paraaortic lymph nodes. Complete dissection of the superior mesenteric lymph nodes with pancreaticoduodenectomy is unlikely to result in cure.

12
UI - 12229158
AU - Sasaki R; Saito K
TI - [Significance of resecting the head of the pancreas for the treatment of gallbladder cancer from the perspective of surgical results and mode of lymph node metastasis]
SO - Nippon Geka Gakkai Zasshi 2002 Aug;103(8):557-63
AD - Department of Surgery I, Iwate Medical University School of Medicine, Morioka, Japan.
The significance of resecting the head of the pancreas was clinicopathologically investigated, predominantly by examining the mode of lymph node metastasis, in patients with gallbladder cancer. Of 60 patients who underwent resection of gallbladder cancer, 24 patients (40.0%) had lymph node metastasis. The breakdown of lymph node metastases was as follows: 12b (24.0%), 16 (21.7%), 13 (17.1%), 8 (12.2%), 12c (12.0%), 12p (8.0%), and 6 (6.3%). Of 45 patients with advanced gallbladder cancer, 14 patients survived more than 5 years after surgery. In the absence of lymph node metastasis, there were some long-term survivors following D0 dissection, gallbladder resection, or liver bed resection. However, all five long-term survivors with lymph node metastasis underwent S4aS5 resection combined with pylorus preserving pancreatoduodenectomy (PPPD) and D3 dissection. Seven patients had number 13 lymph node metastasis, and only two n2 patients who underwent S4aS5 resection combined with PPPD and D3 dissection, survived more than 5 years. There were no long-term survivors with n3 lymph node metastasis. Of the 50 patients who underwent curative resection, 13 patients experienced recurrence: in the liver in six patients, in the peritoneum in four patients, in the lymph nodes in four patients, in the bone in two patients, in the lung in one patient, and local in one patient (including duplicate cases). Of the four patients with lymph node recurrence, two demonstrated number 12 and/or number 13 lymph node metastasis at the time of surgery and underwent bile duct-conserving D2 dissection, although cancer recurred in the head of the pancreas, probably due to recurrence in number 13 lymph node. Extensive resection including resection of the head of the pancreas was therefore effective in patients with up to n2 lymph node metastasis as long as the cancer could be completely sected.

13
UI - 12229159
AU - Miyazaki M; Ito H; Kimura F; Shimizu H
TI - [Postoperative complications and management in the surgical treatment for advanced gallbladder carcinomas]
SO - Nippon Geka Gakkai Zasshi 2002 Aug;103(8):564-70
AD - Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Surgical treatment for advanced gallbladder carcinoma must be based on the extent of the cancer. There are various patterns of cancer spread in advanced gallbladder carcinoma. In cases with hepatic involvement, liver bed resection, hepatic segment Iva + V resection, extended right hepatectomy, or right trisegmentectomy can be selected. In cases with biliary involvement, extended right hepatectomy, pancreaticoduodenectomy, or combined vascular resection can be performed. In cases with gastrointestinal involvement, the involved intestine can be resected with cholecystectomy and bile duct resection. Surgical morbidity rates after surgical treatment for advanced gallbladder carcinoma have been reported to be very high at about 50%, and surgical mortality rates are 7-20%. After extended hepatic resection, surgical mortality rates reach to 30-43%. Hepatopancreaticoduodenectomy (HPD) has a high surgical mortality rate of 25-33%, and combined vascular resection also has a high mortality of 13-67%. To decrease these high morbidity and mortality rates, limited hepatic resection and preoperative portal embolization in hepatic resection, two-stage pancreaticoduodenectomy in HPD, and preservation of the hilar plate at bile duct resection in right hepatic artery resection may be useful. Surgical indications and the choice of operative procedures should be very carefully considered in patients with advanced gallbladder carcinoma because of its high surgical morbidity and mortality rates.

14
UI - 11474391
AU - Desilets DJ; Dy RM; Ku PM; Hanson BL; Elton E; Mattia A; Howell DA
TI - Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications.
SO - Gastrointest Endosc 2001 Aug;54(2):202-8
AD - Division of Gastroenterology, Department of Medicine, Maine Medical Center, Portland, Maine, USA.
BACKGROUND: Adenomas of the major duodenal papilla have malignant potential and are traditionally treated by pancreaticoduodenectomy. This is a report of our experience with endoscopic management and a description of techniques for decreasing complications and enhancing efficacy. METHODS: Forty-one patients were referred for endoscopic management of papillary tumors. If there was no duct invasion and the appearance suggested a benign lesion, biductal sphincterotomy with pancreatic duct stent placement was performed. If the lesion could be elevated by injection of an epinephrine solution, piecemeal resection was performed. The base of the lesion was thermally ablated as needed. Resection/ablation together with stent removal was performed 1 month later. RESULTS: Nine patients (22%) had lesions other than papillary adenoma or cancer. Malignant appearance, ductal stricturing, or extension into the ducts was found in 16 of 41 patients (39%) in whom biopsy specimens alone were obtained. Three patients with adenomas (7%) did not undergo endoscopic resection (because of extremely large lesions and/or comorbid illnesses). Thirteen patients with adenomas (32%) had endoscopic resection; 12 (92%) were lesion-free after 32 ERCPs (mean 2.7). Endoscopic management was unsuccessful in 1 patient (8%). Pancreatitis developed in 1 patient. CONCLUSIONS: Endoscopically treatable papillary neoplasms can be identified on the basis of endoscopic, radiographic, and biopsy features. Preresection sphincterotomy, stent placement, elevation by epinephrine injection, and piecemeal resection may reduce complications and permit more aggressive treatment.

15
UI - 11818948
AU - Lee SK; Kim MH; Seo DW; Lee SS; Park JS
TI - Endoscopic sphincterotomy and pancreatic duct stent placement before endoscopic papillectomy: are they necessary and safe procedures?
SO - Gastrointest Endosc 2002 Feb;55(2):302-4

16
UI - 11895206
AU - Lu JJ; Bains YS; Abdel-Wahab M; Brandon AH; Wolfson AH; Raub WA;
TI - Wilkinson CM; Markoe AM High-dose-rate remote afterloading intracavitary brachytherapy for the treatment of extrahepatic biliary duct carcinoma.
SO - Cancer J 2002 Jan-Feb;8(1):74-8
AD - Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Florida, USA.
PURPOSE: The purpose of this study was to determine whether a dose response exists for extrahepatic bile duct carcinoma (EBDC) when treated with increasingly higher radiation doses delivered via a combination of external beam radiation (EBRT) and high dose rate intracavitary brachytherapy (HDRIB). To establish the best tolerated dose of HDRIB. METHODS AND MATERIALS: Eighteen patients with pathologically proven, locoregional but unresectable or incompletely resected EBDC were studied from 1991-1998 in this phase I/II trial. All patients received EBRT, delivered via megavoltage photons at standard fractionation schedules, for a total dose of 45 Gy. The HDRIB was delivered using the nucleotron HDR remote afterloading unit with a 10 Ci Ir192 source. Each treatment of HDRIB delivered 7 Gy at 1 cm depth. The first group of eight patients received one treatment of HDRIB (Group 1, total dose = 52 Gy). The second group of six patients received two weekly treatments (Group 2, total dose = 59 Gy). The last group of four patients received three weekly treatments of HDRIB (Group 3, total dose = 66 Gy). HDRIB was delivered once weekly concomitant with the EBRT. Acute adverse reactions were evaluated after for each group of patients before escalating to the next higher dose level of HDRIB. RESULTS: The median follow up time for all 18 patients was 15 months. The median survival for all 18 patients was 12.2 months (range 2 to 79.6 months). Overall two-year survival was 27.8%. Three patients (16.7%) had survival of more than 5 years. Dose response is suggested by the median survival of the three groups (9, 12.2, and 20.3 months for Group 1, 2, and 3, respectively), although this did not reach statistical significance. Complete or partial response (>50% reduction in tumor size) was seen in 25% of patients receiving total of 52 Gy compared to 80% of patients (5 patients in Group 2 and 3 patients in Group 3) receiving greater than 59 Gy (P = 0.05). No patients developed Grade 4 complications. One patient in Group 2 developed Grade 3 toxicity after second treatment of HDRIB. CONCLUSION: High dose rate brachytherapy of 21 Gy in three divided weekly treatments, plus 45 Gy of external beam radiation is well tolerated. A dose response is shown with significant increase of PR and CR rate for dose >59 Gy. This modality of treatment appears to be safe and effective for inoperable extrahepatic biliary duct carcinoma.

17
UI - 11931533
AU - Kimura K; Fujita N; Noda Y; Kobayashi G; Ito K
TI - Diagnosis of pT2 gallbladder cancer by serial examinations with endoscopic ultrasound and angiography.
SO - J Gastroenterol 2002;37(3):200-3
AD - Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
BACKGROUND: The prognosis of pT2 gallbladder cancer correlates with whether appropriate surgery for the spread of cancer has been performed. Therefore, accurate preoperative T staging is especially important. We carried out this study to evaluate the usefulness of serial examinations by endoscopic ultrasound (EUS) and angiography for the T staging of pT2 gallbladder cancer. METHODS: Forty-eight patients with gallbladder cancer who underwent both EUS and surgery between 1983 and 1998 were included in this study. The accuracy of serial examination by both EUS and angiography in T staging, based on previously established diagnostic criteria, was retrospectively evaluated. First, the presence or absence of subserosal tumor invasion was assessed by EUS alone. Second, in equivocal cases, the depth of tumor invasion was further evaluated by angiographic findings. RESULTS: Twenty-four patients were correctly diagnosed as having other than pT2 cancer by EUS alone. Angiographic findings were reviewed in 19 of the remaining patients, who had pT1, pT2, or a small number of pT3 lesions. The sensitivity, specificity, and overall accuracy in the T staging of pT2 gallbladder cancer was 81.8%, 90.6%, and 88.4%, respectively. CONCLUSIONS: Serial angiographic examination following adequate patient selection by EUS is effective and efficient for the diagnosis of pT2 gallbladder cancer.

18
UI - 11515633
AU - Vogt M; Jakobs R; Benz C; Arnold JC; Adamek HE; Riemann JF
TI - Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up.
SO - Dig Liver Dis 2000 May;32(4):339-45
AD - Department of Medicine C, Klinikum der Stadt Ludwigshafen gGmbH, Academic Teaching Hospital of the Johannes Gutenberg University of Mainz, Germany. MedCLu@t-online.de
AIMS: To compare the efficacy and the complication rate between endoscopic snare resection of adenomas of Vater's papilla and endoscopic palliation. METHODS: In a retrospective, non randomized manner, we compared long-term results of our endoscopic strategies in 36 patients with histologically confirmed adenoma of Vater's papilla submitted either to local endoscopic snare resection (n=18) or to simple endoscopic palliation (n= 18), respectively. RESULTS: Between 1985 and 1998 results were reviewed. Median age was 76.5 (range 42-89) years in the palliation, and 64.0 (23-89) years in the endoscopic snare resection group. Median duration of follow-up was 33 (6-135) and 75.0 (27-123) months, respectively. The incidence of adenocarcinoma of Vater's papilla was 1 per 52.8 patient-years after endoscopic snare resection and 1 per 15.5 patient-years in the group treated with endoscopic palliation. Compared to the results of endoscopic palliation (prosthesis, sphincterotomy), we found a significant reduction of carcinoma-related death (p=0.0045, McNemar) and adenoma carcinoma-sequence (p=0.007, McNemar) after snare resection. CONCLUSIONS: This retrospective study suggests that complete endoscopic snare resection of adenomas of Vater's papilla will lead to a lower rate of adenoma-carcinoma sequence, to a lower carcinoma-related death rate and probably improves patient survival. These results should be proven prospectively.

19
UI - 12365016
AU - Takada T; Amano H; Yasuda H; Nimura Y; Matsushiro T; Kato H; Nagakawa T;
TI - Nakayama T; Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma.
SO - Cancer 2002 Oct 15;95(8):1685-95
AD - Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. takada@med.teikyo-u.ac.jp
BACKGROUND: To the authors' knowledge, the significance of postoperative adjuvant chemotherapy in pancreaticobiliary carcinoma has not yet been clarified. A randomized controlled study evaluated the effect of postoperative adjuvant therapy with mitomycin C (MMC) and 5-fluorouracil (5-FU) (MF arm) versus surgery alone (control arm) on survival and disease-free survival (DFS) for each specific disease comprising resected pancreaticobiliary carcinoma (pancreatic, gallbladder, bile duct, or ampulla of Vater carcinoma) separately. METHODS: Between April = 173), bile duct (n = 139), gallbladder (n = 140), or ampulla of Vater (n = 56) carcinomas were allocated randomly to either the MF group or the control group. The MF group received MMC (6 mg/m(2) intravenously [i.v.]) at the time of surgery and 5-FU (310 mg/m(2) i.v.) in 2 courses of treatment for 5 consecutive days during postoperative Weeks 1 and 3, followed by 5-FU (100 mg/m(2)orally) daily from postoperative Week 5 until disease recurrence. All patients were followed for 5 years. RESULTS: After ineligible patients were excluded, 158 patients with pancreatic carcinoma (81 in the MF group and 77 in the control group), 118 patients with bile duct carcinoma (58 in the MF group and 60 in the control group), 112 patients with gallbladder carcinoma (69 in the MF group and 43 in the control group), and 48 patients with carcinoma of the ampulla of Vater (24 in the MF group and 24 in the control group) were evaluated. Good compliance (> 80%) was achieved with MF treatment. The 5-year survival rate in gallbladder carcinoma patients was significantly better in the MF group (26.0%) compared with the control group (14.4%) (P = 0.0367). Similarly, the 5-year DFS rate of patients with gallbladder carcinoma was 20.3% in the MF group, which was significantly higher than the 11.6% DFS rate reported in the control group (P = 0.0210). Significant improvement in body weight compared with the control was observed only in patients with gallbladder carcinoma. There were no apparent differences in 5-year survival and 5-year DFS rates between patients with pancreatic, bile duct, or ampulla of Vater carcinomas. Multivariate analyses demonstrated a tendency for the MF group to have a lower risk of mortality (risk ratio of 0.654; P = 0.0825) and recurrence (risk ratio of 0.626; P = 0.0589). The most commonly reported adverse drug reactions were anorexia, nausea/emesis, stomatitis, and leukopenia, none of which were noted to be serious. CONCLUSIONS: The results of the current study indicate that gallbladder carcinoma patients who undergo noncurative resections may derive some benefit from systemic chemotherapy. However, alternative modalities must be developed for patients with carcinomas of the pancreas, bile duct, or ampulla of Vater. Copyright 2002 American Cancer Society.

20
UI - 12094137
AU - Leone N; De Paolis P; Garino M; Brunello F; Carrera M; Pellicano R;
TI - Fronda GR; Bumma C; Rizzetto M Surgery for carcinoma of the gallbladder. Our experience.
SO - Panminerva Med 2002 Sep;44(3):227-31
AD - Department of Gastroenterology, Ospedale S. Giovanni Battista, Turin, Italy. leone.nic@tiscalinet.it
BACKGROUND: Carcinoma of the gallbladder is a gastrointestinal malignancy with a very poor prognosis. The 5-year survival rate amounts to less than 5% in most series. In this study we reviewed the results of surgical treatment for gallbladder carcinoma with special reference to extended radical procedures. METHODS: Between 1995 and 2000 we enrolled 36 patients (17 males and 19 females), 24 of whom were treated with simple cholecystectomy and 12 with radical resection (partial hepatectomy, regional lymphadenectomy, and common bile duct resection). The tumours were classified by stage using the criteria of the American Joint Committee on Cancer (AJCC). Stages, operative procedures, results of pathologic examinations and the outcome of the resected cases were reviewed. RESULTS: There were 2 postoperative deaths (0.55%). The mean follow-up period was 19.1 months (range 1-60). For stage I and II disease extended cholecystectomy had a better result than simple cholecystectomy: the 5-year survival rates were 38.4 versus 19%, respectively. For the patients with advanced stage III or IV gallbladder carcinoma, a significant advantage of survival resulted in case of liver resection as compared to surgical treatment without liver resection: the 5-year survival rates were 20 and 0%, respectively. CONCLUSIONS: The survival of stage I-II patients was good. For the patients in higher stages the prognosis was significantly worse. In these cases more aggressive surgery may be needed.

21
UI - 12243816
AU - Kim S; Kim SW; Bang YJ; Heo DS; Ha SW
TI - Role of postoperative radiotherapy in the management of extrahepatic bile duct cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Oct 1;54(2):414-9
AD - Department of Therapeutic Radiology, Seoul National University College of Medicine, Chongno-gu, Seoul, South Korea.
PURPOSE: To analyze the outcome of postoperative radiotherapy (RT) or chemoradiation for patients with extrahepatic bile duct cancer who had undergone either curative or palliative surgery, and to identify the prognostic factors for these patients. METHODS AND MATERIALS: Between cancer underwent RT at the Department of Therapeutic Radiology, Seoul National University Hospital. Of these patients, 84 were included in this retrospective study. The male/female ratio was 3.7:1 (66 men and 18 women). The median age of the patients was 58 years (range 33-76). Gross total surgical resection was performed in 72 patients, with pathologically negative margins in 47 and microscopically positive margins in 25. Twelve patients underwent surgical exploration and biopsy or subtotal resection with palliative bypass procedures. All the patients received >40 Gy of external beam RT after surgery. Concurrent 5-fluorouracil was administered during external beam RT in 71 patients, and maintenance chemotherapy was performed in 61 patients after RT completion. The minimal follow-up of the survivors was 14 months, and the median follow-up period for all the patients was 23 months (range 2-75). RESULTS: The overall 2- and 5-year survival rate was 52% and 31%, respectively. The 2- and 5-year disease-free survival rate was 48% and 26%, respectively. On univariate analysis using the Kaplan-Meier product limit method, the use of chemotherapy, performance status, N stage, size of residual tumor, stage, and tumor location were significant prognostic factors. However, on multivariate analysis using Cox's proportional hazard model, N stage (N0 vs. N1 and N2, p = 0.02) was the only significant prognostic factor. CONCLUSION: Long-term survival can be expected in patients with extrahepatic bile duct cancer who undergo radical surgery and postoperative chemoradiation. Regional lymph node metastasis is a poor prognostic factor for these patients.

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