Limits...
Is an aggressive surgical approach worthwhile in biliary cancer?

Ristagno N, Knuth A, Pestalozzi BC - Int Semin Surg Oncol (2007)

Bottom Line: Patients undergoing resection during the second time period were more likely to be without relapse compared with patients undergoing resection in the first time period.Resected patients had better survival compared with unresected patients for all tumor locations (gallbladder, extrahepatic and intrahepatic cholangiocarcinomas).Overall survival of patients was not significantly different between patients treated during the first versus the second time period.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, University Hospital, Raemistrasse 100, 8091 Zürich, Switzerland. bernhard.pestalozzi@usz.ch.

ABSTRACT

Background: Biliary cancer includes cancer of the gallbladder as well as extrahepatic and intrahepatic cholangiocarcinoma. Surgery is the only curative treatment option available. Recently, much more aggressive surgical approaches have been employed. Therefore, we have investigated outcome of biliary cancer before and after establishment of an aggressive surgical approach.

Methods: Retrospective single-center analysis comparing two time periods of 5 years each. During the second period new surgical expertise and a much more aggressive surgical approach were used.

Results: In the first time period (5/1995-4/2000) only 29 patients with biliary cancer were treated at our institution, while a total of 85 patients were treated during the second time period (5/2000-4/2005). Surgical resection was attempted in 55% during the first period versus 62% in the second; resection was complete in 37.5% and 58.5%, respectively. Patients undergoing resection during the second time period were more likely to be without relapse compared with patients undergoing resection in the first time period. No patient from the first period is without evidence of disease, compared to 11 patients operated in the second period. Resected patients had better survival compared with unresected patients for all tumor locations (gallbladder, extrahepatic and intrahepatic cholangiocarcinomas). Overall survival of patients was not significantly different between patients treated during the first versus the second time period.

Conclusion: In patients with biliary cancer surgical resection should be attempted whenever possible. However, long-term survival can be achieved only when a complete resection is obtained.

No MeSH data available.


Related in: MedlinePlus

Proportion without relapse after resection. The proportion of patients without relapse over time is shown for the two time periods. In the first period only 6 of 16 resected patients had complete resections (37.5%), 10 have relapsed immediately. In the second time period 31 of 53 patients had complete resections (58.5%), 22 had relapsed immediately. Similarly during further follow-up, time to relapse after resection remained increased for the second time period (p = 0.064).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2211286&req=5

Figure 1: Proportion without relapse after resection. The proportion of patients without relapse over time is shown for the two time periods. In the first period only 6 of 16 resected patients had complete resections (37.5%), 10 have relapsed immediately. In the second time period 31 of 53 patients had complete resections (58.5%), 22 had relapsed immediately. Similarly during further follow-up, time to relapse after resection remained increased for the second time period (p = 0.064).

Mentions: The only curative treatment of cholangiocarcinoma is surgical resection. In the first time period, 12 of 29 patients underwent resection with curative intent (41.4%), compared to 51 of 85 (60.0%) in the second time period. Follow-up of surgically resected patients is shown in Figure 1. Time to relapse is longer for patients treated in the second time period (p = 0.064). In the first time period only 6 of 16 (37.5%) resections were complete resections, compared to 31 of 53 (58.5%) resections in the second time period. All 6 patients of the first time period having undergone complete resection have relapsed. So far, 20 of the 31 later patients having undergone complete resection have relapsed, while 11 patients are without evidence of disease (2 of them lost to follow-up). One exceptional case has been successfully treated with combined modality therapy involving neoadjuvant chemo-radiation followed by living donor liver transplantation from a sibling who had previously donated bone marrow to the patient for acute lymphoblastic leukaemia.[5,6]


Is an aggressive surgical approach worthwhile in biliary cancer?

Ristagno N, Knuth A, Pestalozzi BC - Int Semin Surg Oncol (2007)

Proportion without relapse after resection. The proportion of patients without relapse over time is shown for the two time periods. In the first period only 6 of 16 resected patients had complete resections (37.5%), 10 have relapsed immediately. In the second time period 31 of 53 patients had complete resections (58.5%), 22 had relapsed immediately. Similarly during further follow-up, time to relapse after resection remained increased for the second time period (p = 0.064).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211286&req=5

Figure 1: Proportion without relapse after resection. The proportion of patients without relapse over time is shown for the two time periods. In the first period only 6 of 16 resected patients had complete resections (37.5%), 10 have relapsed immediately. In the second time period 31 of 53 patients had complete resections (58.5%), 22 had relapsed immediately. Similarly during further follow-up, time to relapse after resection remained increased for the second time period (p = 0.064).
Mentions: The only curative treatment of cholangiocarcinoma is surgical resection. In the first time period, 12 of 29 patients underwent resection with curative intent (41.4%), compared to 51 of 85 (60.0%) in the second time period. Follow-up of surgically resected patients is shown in Figure 1. Time to relapse is longer for patients treated in the second time period (p = 0.064). In the first time period only 6 of 16 (37.5%) resections were complete resections, compared to 31 of 53 (58.5%) resections in the second time period. All 6 patients of the first time period having undergone complete resection have relapsed. So far, 20 of the 31 later patients having undergone complete resection have relapsed, while 11 patients are without evidence of disease (2 of them lost to follow-up). One exceptional case has been successfully treated with combined modality therapy involving neoadjuvant chemo-radiation followed by living donor liver transplantation from a sibling who had previously donated bone marrow to the patient for acute lymphoblastic leukaemia.[5,6]

Bottom Line: Patients undergoing resection during the second time period were more likely to be without relapse compared with patients undergoing resection in the first time period.Resected patients had better survival compared with unresected patients for all tumor locations (gallbladder, extrahepatic and intrahepatic cholangiocarcinomas).Overall survival of patients was not significantly different between patients treated during the first versus the second time period.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, University Hospital, Raemistrasse 100, 8091 Zürich, Switzerland. bernhard.pestalozzi@usz.ch.

ABSTRACT

Background: Biliary cancer includes cancer of the gallbladder as well as extrahepatic and intrahepatic cholangiocarcinoma. Surgery is the only curative treatment option available. Recently, much more aggressive surgical approaches have been employed. Therefore, we have investigated outcome of biliary cancer before and after establishment of an aggressive surgical approach.

Methods: Retrospective single-center analysis comparing two time periods of 5 years each. During the second period new surgical expertise and a much more aggressive surgical approach were used.

Results: In the first time period (5/1995-4/2000) only 29 patients with biliary cancer were treated at our institution, while a total of 85 patients were treated during the second time period (5/2000-4/2005). Surgical resection was attempted in 55% during the first period versus 62% in the second; resection was complete in 37.5% and 58.5%, respectively. Patients undergoing resection during the second time period were more likely to be without relapse compared with patients undergoing resection in the first time period. No patient from the first period is without evidence of disease, compared to 11 patients operated in the second period. Resected patients had better survival compared with unresected patients for all tumor locations (gallbladder, extrahepatic and intrahepatic cholangiocarcinomas). Overall survival of patients was not significantly different between patients treated during the first versus the second time period.

Conclusion: In patients with biliary cancer surgical resection should be attempted whenever possible. However, long-term survival can be achieved only when a complete resection is obtained.

No MeSH data available.


Related in: MedlinePlus