Malignant biliary obstruction
Authors:
doc. MUDr. Ph.D. Tomáš Hucl
Authors place of work:
Klinika hepatogastroenterologie IKEM
Published in the journal:
Čas. Lék. čes. 2016; 155: 30-37
Category:
Review Articles
Summary
Pancreatic cancer and cholangiocarcinoma are the most common causes of malignant biliary obstruction. They are diseases of increasing incidence and unfavorable prognosis. Only patients with localized disease indicated for surgery have a chance of long-term survival. These patients represent less than 20 % of all patients, despite the progress in our diagnostic abilities.
Locally advanced and metastatic tumors are treated with palliative chemotherapy or chemoradiotherapy; the results of such treatments are unsatisfactory. The average survival of patients with unresectable disease is 6 months and only 5–10 % of patients survive 5 years.
Biliary drainage is an integral part of palliative treatment. Endoscopically or percutaneosly placed stents improve quality of life, decrease cholestasis and pruritus, but do not significantly improve survival. Biliary stents get occluded over time, possibly resulting in acute cholangitis and require repeated replacement.
Photodynamic therapy and radiofrequency ablation, locally active endoscopic methods, have been increasingly used in recent years in palliative treatment of patients with malignant biliary obstruction. In photodynamic therapy, photosensitizer accumulates in tumor tissue and is activated 48 hours later by light of a specific wave length. Application of low voltage high frequency current during radiofrequency ablation results in tissue destruction by heat. Local ablation techniques can have a significant impact in a large group of patients with malignant biliary obstruction, leading to improved prognosis, quality of life and stent patency.
Keywords:
cholangiocarcinoma, pancreatic cancer, stent, photodynamic therapy, radifrequency ablation, brachytherapy
Zdroje
1. Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology 2013; 145(6): 1215−1229.
2. Deoliveira ML, Schulick RD, Nimura Y et al. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology 2011; 53(4): 1363−1371.
3. Khan SA, Davidson BR, Goldin RD et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut 2012; 61(12): 1657−1669.
4. Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol 2013; 28(4): 593−607.
5. Lowenfels AB, Maisonneuve P. Epidemiology and risk factors for pancreatic cancer. Best Pract Res Clin Gastroenterol 2006; 20(2): 197−209.
6. Vincent A, Herman J, Schulick R et al. Pancreatic cancer. Lancet 2011; 378(9791): 607−620.
7. Ponchon T, Gagnon P, Berger F et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc 1995; 42(6): 565−572.
8. Oliverius M, Kala Z, Varga M et al. Radical surgery for pancreatic malignancy in the elderly. Pancreatology 2010; 10(4): 499−502.
9. Witzigmann H, Berr F, Ringel U et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann Surg 2006; 244(2): 230−239.
10. Van Laethem JL, Verslype C, Iovanna JL et al. New strategies and designs in pancreatic cancer research: consensus guidelines report from a European expert panel. Ann Oncol 2012; 23(3): 570−576.
11. Glimelius B, Hoffman K, Sjoden PO et al. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol 1996; 7(6): 593−600.
12. Valle J, Wasan H, Palmer DH et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362(14): 1273−1281.
13. Conroy T, Desseigne F, Ychou M et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364(19): 1817−1825.
14. Goldstein D, El-Maraghi RH, Hammel P et al. Nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer: long-term survival from a phase III trial. J Natl Cancer Inst 2015; 107(2).
15. van der Gaag NA, Rauws EA, van Eijck CH et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362(2): 129−137.
16. Siddiqui AA, Mehendiratta V, Loren D et al. Self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline-resectable pancreatic cancer: outcomes in 241 patients. Dig Dis Sci 2013; 58(6): 1744−1750.
17. Liu F, Li Y, Wei Y, Li B. Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? A systematic review. Dig Dis Sci 2011; 56(3): 663−672.
18. Davids PH, Groen AK, Rauws EA et al. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340(8834–8835): 1488−1492.
19. Almadi MA, Barkun AN, Martel M. No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11(1): 27−37.e1.
20. Suk KT, Kim HS, Kim JW et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc 2006; 64(4): 522−529.
21. Sangchan A, Kongkasame W, Pugkhem A et al. Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. Gastrointest Endosc 2012; 76(1): 93−99.
22. Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 1998; 47(5): 354−362.
23. Dowsett JF, Vaira D, Hatfield AR et al. Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology. 1989; 96(4): 1180−1186.
24. Vienne A, Hobeika E, Gouya H et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010; 72(4): 728−735.
25. Paik WH, Park YS, Hwang JH et al. Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach. Gastrointest Endosc 2009; 69(1): 55−62.
26. Maranki J, Hernandez AJ, Arslan B et al. Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy 2009; 41(6): 532−538.
27. O'Brien S, Hatfield AR, Craig PI, Williams SP. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut 1995; 36(4): 618−621.
28. Patel J, Rizk N, Kahaleh M. Role of photodynamic therapy and intraductal radiofrequency ablation in cholangiocarcinoma. Best Pract Res Clin Gastroenterol 2015; 29(2): 309−318.
29. Tomizawa Y, Tian J. Photodynamic therapy for unresectable cholangiocarcinoma. Dig Dis Sci 2012; 57(2): 274−283.
30. McCaughan JS jr., Mertens BF, Cho C et al. Photodynamic therapy to treat tumors of the extrahepatic biliary ducts. A case report. Arch Surg 1991; 126(1): 111−113.
31. Dumoulin FL, Gerhardt T, Fuchs S et al. Phase II study of photodynamic therapy and metal stent as palliative treatment for nonresectable hilar cholangiocarcinoma. Gastrointest Endosc 2003; 57(7): 860−867.
32. Ortner ME, Caca K, Berr F et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 2003; 125(5): 1355−1363.
33. Zoepf T, Jakobs R, Arnold JC et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol 2005; 100(11): 2426−2430.
34. Kahaleh M, Mishra R, Shami VM et al. Unresectable cholangiocarcinoma: comparison of survival in biliary stenting alone versus stenting with photodynamic therapy. Clin Gastroenterol Hepatol 2008; 6(3): 290−297.
35. Hong MJ, Cheon YK, Lee EJ et al. Long-term outcome of photodynamic therapy with systemic chemotherapy compared to photodynamic therapy alone in patients with advanced hilar cholangiocarcinoma. Gut Liver 2014; 8(3): 318−323.
36. Park do H, Lee SS, Park SE et al. Randomised phase II trial of photodynamic therapy plus oral fluoropyrimidine, S-1, versus photodynamic therapy alone for unresectable hilar cholangiocarcinoma. Eur J Cancer 2014; 50(7): 1259−1268.
37. Reddy DN, Ramchandani M. Endoscopic palliation of advanced cholangiocarcinoma: can we go beyond stenting? Gastrointest Endosc 2014; 80(5): 805−806.
38. Steel AW, Postgate AJ, Khorsandi S et al. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 2011; 73(1): 149−153.
39. Dolak W, Schreiber F, Schwaighofer H et al. Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc 2014; 28(3): 854−860.
40. Kallis Y, Phillips N, Steel A et al. Analysis of Endoscopic Radiofrequency Ablation of Biliary Malignant Strictures in Pancreatic Cancer Suggests Potential Survival Benefit. Dig Dis Sci 2015; 60(11): 3449−3455.
41. Strand DS, Cosgrove ND, Patrie JT et al. ERCP-directed radiofrequency ablation and photodynamic therapy are associated with comparable survival in the treatment of unresectable cholangiocarcinoma. Gastrointest Endosc 2014; 80(5): 794−804.
42. Roque J, Ho SH, Reddy N, Goh KL. Endoscopic ablation therapy for biliopancreatic malignancies. Clin Endosc 2015; 48(1): 15−19.
43. Tal AO, Vermehren J, Friedrich-Rust M et al. Intraductal endoscopic radiofrequency ablation for the treatment of hilar non-resectable malignant bile duct obstruction. World J Gastrointest Endosc 2014; 6(1): 13−19.
44. Brůha R, Petrtýl J, Kubecová M et al. Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies − the question of long-term palliation. Hepatogastroenterology 2001; 48(39): 631−637.
45. Válek V, Kysela P, Kala Z et al. Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma: a prospective randomised study. Eur J Radiol 2007; 62(2): 175−179.
Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
Journal of Czech Physicians
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Pancreatic cancer – current effective diagnostic and therapeutic approach
- Malignant biliary obstruction
- Professor Josef Marek - octogenarian
- Foregut diseases: foregut neoplasms