Biliary tract cancer(BTC)is a rare disease with few available treatment options.Tumor malignancy and surgical invasiveness vary depending on the site of the lesion.Perioperative mortality remains high,particularly in ...Biliary tract cancer(BTC)is a rare disease with few available treatment options.Tumor malignancy and surgical invasiveness vary depending on the site of the lesion.Perioperative mortality remains high,particularly in patients with hilar cholangiocarcinoma and gallbladder cancer.Benchmark cases from high-volume centers have reported high surgical complications(87%)and 3-month mortality rates(13%).Japanese studies of hepatopancreatoduodenectomy have reported that although the complication rate is higher in high-volume centers than in other institutions,the mortality rate is low;operative safety depends on adequate liver volume after resection by portal vein embolization,cholangitis reduction,and comprehensive management of postoperative complications.Robot-assisted surgery is increasingly common in patients treated with pancreaticoduodenectomy even after distal pancreatectomy.However,many challenges exist due to device and visibility issues.Recently,adjuvant chemotherapies have been developed for the treatment of BTC.The introduction of immune checkpoint inhibitors and discovery of oncogenic driver genes have increased the number of promising treatment options.Innovations in targeted drug therapy,including fibroblast growth factor receptor inhibitors and immune checkpoint inhibitors,have shown efficacy and broadened the treatment options for unresectable BTC.Therefore,a multidisciplinary treatment strategy based on surgical intervention is desirable.展开更多
The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Rouxen-Y hepaticojejunostomy for congenital biliary dilatation at the age of 7.Thereafter,she suffered from recurrent a...The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Rouxen-Y hepaticojejunostomy for congenital biliary dilatation at the age of 7.Thereafter,she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy.She developed a pancreatic fistula and an intra-abdominal abscess after the operation.These complications were improved by percutaneous abscess drainage and antibiotic therapy.How ever,upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy.Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography,we tried an endoscopic ultrasonography(EUS) guided rendezvous technique for pancreatic duct drainage.After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle,the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis.We changed the echoendoscope to an oblique-viewing endoscope,then grasped the guidewire and withdrew it through the scope.The stenosis of the pancreaticojejunostomy was dilated up to 4 mm,and a pancreatic stent was put in place.Though the pancreatic stent was removed after three months,the patient remained symptomfree.Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.展开更多
文摘Biliary tract cancer(BTC)is a rare disease with few available treatment options.Tumor malignancy and surgical invasiveness vary depending on the site of the lesion.Perioperative mortality remains high,particularly in patients with hilar cholangiocarcinoma and gallbladder cancer.Benchmark cases from high-volume centers have reported high surgical complications(87%)and 3-month mortality rates(13%).Japanese studies of hepatopancreatoduodenectomy have reported that although the complication rate is higher in high-volume centers than in other institutions,the mortality rate is low;operative safety depends on adequate liver volume after resection by portal vein embolization,cholangitis reduction,and comprehensive management of postoperative complications.Robot-assisted surgery is increasingly common in patients treated with pancreaticoduodenectomy even after distal pancreatectomy.However,many challenges exist due to device and visibility issues.Recently,adjuvant chemotherapies have been developed for the treatment of BTC.The introduction of immune checkpoint inhibitors and discovery of oncogenic driver genes have increased the number of promising treatment options.Innovations in targeted drug therapy,including fibroblast growth factor receptor inhibitors and immune checkpoint inhibitors,have shown efficacy and broadened the treatment options for unresectable BTC.Therefore,a multidisciplinary treatment strategy based on surgical intervention is desirable.
基金Supported by Grant-in-Aid to the Research Committee of the Intractable Pancreatic Diseases(Chairman,Shimosegawa T),provided from the Ministry of Health,Labour and Welfare of Japan
文摘The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Rouxen-Y hepaticojejunostomy for congenital biliary dilatation at the age of 7.Thereafter,she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy.She developed a pancreatic fistula and an intra-abdominal abscess after the operation.These complications were improved by percutaneous abscess drainage and antibiotic therapy.How ever,upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy.Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography,we tried an endoscopic ultrasonography(EUS) guided rendezvous technique for pancreatic duct drainage.After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle,the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis.We changed the echoendoscope to an oblique-viewing endoscope,then grasped the guidewire and withdrew it through the scope.The stenosis of the pancreaticojejunostomy was dilated up to 4 mm,and a pancreatic stent was put in place.Though the pancreatic stent was removed after three months,the patient remained symptomfree.Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.
