Objective:This study aimed to evaluate the associations of baseline income,cumulative income exposure,and income volatility with the incidence of pancreatic and biliary tract cancers in a nationwide Korean cohort.Meth...Objective:This study aimed to evaluate the associations of baseline income,cumulative income exposure,and income volatility with the incidence of pancreatic and biliary tract cancers in a nationwide Korean cohort.Methods:We analyzed 3,361,091 adults aged 30-65 years who underwent the 2012 National Health Insurance Service(NHIS)health screening.Income level was derived from insurance premium data assessed over the five years preceding baseline(2008-2012)and categorized into baseline income quartiles,cumulative exposure to low or high income,and income volatility based on annual percentage changes.Incident pancreatic and biliary tract cancers were identified using diagnostic codes and the copayment reduction registry.Associations were evaluated using Cox proportional hazards models with adjustment for demographic,lifestyle,and clinical covariates,and cumulative incidence was compared using Kaplan-Meier curves.Results:During a median follow-up of 9.6 years,14,469 pancreatic cancers and 6,647 biliary tract cancers were newly diagnosed.Lower baseline income was associated with a higher risk of pancreatic and biliary tract cancers,whereas sustained high-income exposure was associated with reduced risk.Cumulative low-income exposure showed a positive linear trend with pancreatic cancer incidence.Income volatility was modestly associated with pancreatic cancer and was positively associated with biliary tract cancer in the fully adjusted model.These associations were generally consistent across subgroups,with a stronger inverse association between prolonged high-income exposure and pancreatic cancer among individuals without diabetes.Conclusions:Income level and income stability were significantly associated with the incidence of pancreatic and biliary tract cancers.Lower baseline income was associated with higher risk,whereas sustained high-income exposure was protective.Income volatility was associated with increased cancer risk,particularly for biliary tract cancer.These findings highlight the importance of incorporating income dynamics into cancer prevention strategies and addressing socioeconomic instability among vulnerable populations.展开更多
Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially c...Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially curative treatment,yet only one-fifth of patients are eligible for resection at initial diagnosis[3].Threedimensional(3D)reconstruction technology provides precise preoperative visualization of complex hilar anatomy,significantly enhancing surgical planning and outcomes[4].Recent advances in 3D reconstruction technology have enhanced preoperative planning by providing precise anatomical mapping of tumor-vessel relationships and biliary variations[4,5].Therefore,this report describes a case of left iCCA successfully resected with biliary reconstruction guided by 3D visualization.展开更多
BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after ...BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after primary surgery.Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong University.All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was uneventful.All patients were followed-up at the surgical outpatient department for six months to three years.So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.展开更多
AIM: To investigate the effects of biliary tract external drainage(BTED) on intestinal barrier injury in rats with hemorrhagic shock(HS). METHODS: BTED was performed via cannula insertion into the bile duct of rats. H...AIM: To investigate the effects of biliary tract external drainage(BTED) on intestinal barrier injury in rats with hemorrhagic shock(HS). METHODS: BTED was performed via cannula insertion into the bile duct of rats. HS was induced by drawing blood from the femoral artery at a rate of 1 m L/min until a mean arterial pressure(MAP) of 40 ± 5 mm Hg was achieved. That MAP was maintained for 60 min. A total of 99 Sprague-Dawley rats were randomized into a sham group, an HS group and an HS + BTED group. Nine rats in the sham group were sacrificed 0.5 h after surgery. Nine rats in each of the HS and HS + BTED groups were sacrificed 0.5 h, 1 h, 2 h, 4 h and 6 h after resuscitation. Plasma tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), and lipopolysaccharide(LPS) levels were analyzed using enzyme-linked immunosorbent assay. Plasma D-lactate levels were analyzed using colorimetry. The expression levels of occludin and claudin-1 in the ileum were analyzed using Western blot and immunohistochemistry. Histology of the ileumwas evaluated by hematoxylin and eosin staining. RESULTS: Plasma TNF-α levels in the HS + BTED group decreased significantly compared with the HS group at 1 h and 6 h after resuscitation(P < 0.05). Plasma IL-6 levels in the HS + BTED group decreased significantly compared with the HS group at 0.5 h, 1 h and 2 h after resuscitation(P < 0.05). Plasma D-lactate and LPS levels in the HS + BTED group decreased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). The expression levels of occludin in the HS + BTED group increased significantly compared with the HS group at 4 h and 6 h after resuscitation(P < 0.05). The expression levels of claudin-1 in the HS + BTED group increased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). Phenomena of putrescence and desquamation of epithelial cells in the ileal mucosa were attenuated in the HS + BTED group. Ileal histopathologic scores in the HS + BTED group decreased significantly compared with the HS group at 2 h, 4 h and 6 h after resuscitation(P < 0.05). CONCLUSION: BTED protects against intestinal barrier injury in HS rats.展开更多
Background:Immune checkpoint inhibitors(ICIs)are effective in a subset of patients with metastatic solid tumors.However,the patients who would benefit most from ICIs in biliary tract cancer(BTC)are still controversial...Background:Immune checkpoint inhibitors(ICIs)are effective in a subset of patients with metastatic solid tumors.However,the patients who would benefit most from ICIs in biliary tract cancer(BTC)are still controversial.Materials and methods:We molecularly characterized tissues and blood from 32 patients with metastatic BTC treated with the ICI pembrolizumab as second-line therapy.Results:All patients had microsatellite stable(MSS)type tumors.Three of the 32 patients achieved partial response(PR),with an objective response rate(ORR)of 9.4%(95%confidence interval[CI],2.0–25.2)and nine showed stable disease(SD),exhibiting a disease control rate(DCR)of 37.5%(95%CI,21.1–56.3).For the 31 patients who had access to PD-1 ligand 1(PD-L1)combined positive score(CPS)testing(cut-off value≥1%),the ORR was not different between those who had PD-L1-positive(PD-L1+;1/11,9.1%)and PDL1-(2/20,10.0%)tumors(p=1.000).The tumor mutational burden(TMB)of PD-L1+BTC was comparable to that of PD-L1-BTC(p=0.630).TMB and any exonic somatic mutations were also not predictive of pembrolizumab response.Molecular analysis of blood and tumor samples demonstrated a relatively high natural killer(NK)cell proportion in the peripheral blood before pembrolizumab treatment in patients who achieved tumor response.Moreover,the tumors of these patients presented high enrichment scores for NK cells,antitumor cytokines,and Th1 signatures,and a low enrichment score for cancer-associated fibroblasts.Conclusions:This study shows the molecular characteristics associated with the efficacy of pembrolizumab in BTC of the MSS type.展开更多
Biliary tract cancer(BTC)is a group of heterogeneous sporadic diseases,including intrahepatic,hilar,and distal cholangiocarcinoma,as well as gallbladder cancer.BTC is characterized by high invasiveness and extremely p...Biliary tract cancer(BTC)is a group of heterogeneous sporadic diseases,including intrahepatic,hilar,and distal cholangiocarcinoma,as well as gallbladder cancer.BTC is characterized by high invasiveness and extremely poor prognosis,with a global increased incidence due to intrahepatic cholangiocarcinoma(ICC).The 18Ffludeoxyglucose positron emission tomography(PET)computed tomography(18F-FDG PET/CT)combines glucose metabolic information(reflecting the glycolytic activity of tumor cells)with anatomical structure to assess tumor metabolic heterogeneity,systemic metastasis,and molecular characteristics noninvasively,overcoming the limitations of traditional imaging in the detection of micrometastases and recurrent lesions.18F-FDG PET/CT offers critical insights in clinical staging,therapeutic evaluation,and prognostic prediction of BTC.This article reviews research progress in this field over the past decade,with a particular focus on the advances made in the last 3 years,which have not been adequately summarized and recognized.The research paradigm in this field is shifting from qualitative to quantitative studies,and there have been significant breakthroughs in using 18F-FDG PET/CT metabolic information to predict gene expression in ICC.Radiomics and deep learning techniques have been applied to ICC for prognostic prediction and differential diagnosis.Additionally,PET/magnetic resonance imaging is increasingly demonstrating its value in this field.展开更多
A clinical trial of nab-paclitaxel plus capecitabine as a first-line treatment for advanced biliary tract cancers was conducted.We analyzed the development of systemic therapy recommended by the National Comprehensive...A clinical trial of nab-paclitaxel plus capecitabine as a first-line treatment for advanced biliary tract cancers was conducted.We analyzed the development of systemic therapy recommended by the National Comprehensive Cancer Network guidelines and the development of nab-paclitaxel combination chemotherapy for advanced biliary tract cancers(BTCs)and concluded that nab-paclitaxel plus capecitabine is a promising first-line regimen for advanced BTCs.展开更多
BACKGROUND Biliary tract cancer(BTC)is a rare,aggressive malignancy with increasing inci-dence and poor prognosis.Identifying preoperative prognostic factors is crucial for effective risk-benefit assessments and patie...BACKGROUND Biliary tract cancer(BTC)is a rare,aggressive malignancy with increasing inci-dence and poor prognosis.Identifying preoperative prognostic factors is crucial for effective risk-benefit assessments and patient stratification.The prognostic nutritional index(PNI),which reflects immune-inflammatory and nutritional status,has shown prognostic value in various cancers,but its significance in BTC remains unclear.AIM To assess the prognostic value of the preoperative PNI in BTC patients,with a focus on overall survival(OS)and disease-free survival(DFS).METHODS Comprehensive searches were conducted in the PubMed,EMBASE,and Web of Science databases from inception to April 2024.The primary outcomes of interest focused on the associations between the preoperative PNI and the prognosis of BTC patients,specifically OS and disease-free survival(DFS).Statistical analyses were conducted via STATA 17.0 software.RESULTS Seventeen studies encompassing 4645 patients met the inclusion criteria.Meta-analysis revealed that a low PNI was significantly associated with poorer OS[hazard ratio(HR)1.91,95%CI:1.59-2.29;P<0.001]and DFS(HR 1.93,95%CI:1.39-2.67;P<0.001).Subgroup analyses revealed consistent results across BTC subtypes(cholangiocarcinoma and gallbladder cancer)and stages(resectable and advanced).Sensitivity analyses confirmed the robustness of these findings,and no significant publication bias was detected.CONCLUSION This study demonstrated that a low preoperative PNI predicts poor OS and DFS in BTC patients,highlighting its potential as a valuable prognostic tool.Further prospective studies are needed to validate these findings and enhance BTC patient management.展开更多
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
Molecular profiling of biliary tract cancers(BTCs)has paved the way for a broader range of therapeutic options,leading to improved survival outcomes.Given the challenges of tissue evaluation in BTCs,circulating tumor ...Molecular profiling of biliary tract cancers(BTCs)has paved the way for a broader range of therapeutic options,leading to improved survival outcomes.Given the challenges of tissue evaluation in BTCs,circulating tumor DNA(ct-DNA)has emerged as a promising non-invasive biomarker for genomic profiling.Bile has been proven to be a reliable ctDNA source,demonstrating higher concordance with tumor tissue than plasma.More importantly,ctDNA provides valuable insights into both clonal evolution and treatment response,including the detection of resistance mechanisms and mutation clearance,which are often associated with disease control.Although its role in recurrence monitoring remains investigational,early studies suggest that ctDNA detection may precede radiological recurrences.This review examines recent advancements in ctDNA analysis for patients with BTC,highlighting key developments,current clinical implications,and ongoing challenges.Large-scale prospective studies are needed to validate the clinical utility of ctDNA and to support its integration into BTC management.展开更多
BACKGROUND: Biliary tract injuries are mostly iatrogenic Related data are limited in developing countries. There are lessons to be learned by revisiting the clinical profiles management issues and outcome of patients ...BACKGROUND: Biliary tract injuries are mostly iatrogenic Related data are limited in developing countries. There are lessons to be learned by revisiting the clinical profiles management issues and outcome of patients referred to a tertiary care center in Sri Lanka, compared with the previous data from the same center published in 2006. Such a review is particularly relevant at a time of changing global perceptions of iatrogenic biliary injuries. This study aimed to analyze and compare the changes in the injury pattern, management and outcome following biliary tract injury in a Sri Lankan study population treated at a tertiary care center. METHODS: A retrospective analysis was made of 67 patients treated between May 2002 and February 2011. The profiles of the last 38 patients treated from October 2006 to February 2011 were compared with those of the first 29 patients treated from May 2002 to September 2006. Definitive management options included endoscopic biliary stenting, reconstructive hepaticojejunostomy with creation of gastric access loops and biliary stricture dilation. Post-treatment jaundice cholangitis and abdominal pain needing intervention were considered as treatment failures. RESULTS: In the 67 patients, 55 were women and 12 men Their mean age was 40.6 (range 19-80) years. Five patients had traumatic injuries. Thirty-seven injuries (23 during the second study period) were due to laparoscopic cholecystectomy and 25 (10 during the second study period) to open cholecystectomy The identification rate of intra-operative injury was 19% in the laparoscopic group and 8% in the open group. Bismuth typeI, II, III and IV injuries were seen in 18, 18, 15 and 12 patients, respectively. Endoscopic stenting was the definitive treatment in 20 patients. In 35 patients who had hepaticojejunostomy, 33 underwent creation of the gastric access loop. Twenty- two reconstructions were performed during the second study period. A gastric access loop was used for endotherapy in three patients with anastomotic occlusion at the site of hepaticojejunostomy. The overall outcome was satisfactory in the majority of patients. There were four injury-related deaths. CONCLUSIONS: Biliary tract injuries associated with laparoscopic cholecystectomy have become the most frequent cause of biliary injury management at our center. Although endotherapy was useful in selected patients, in the majority, surgical reconstruction with hepaticojejunostomy was required as the definitive treatment. Creation of the gastric access loop was found to be a useful adjunct in the management of hepaticojejunostomy strictures.展开更多
Background:With increasing life expectancy and aging populations,Belt and Road Initiative(BRI)countries face various levels of gallbladder and biliary tract cancer(GBTC)impact.This study analyzed differences in the bu...Background:With increasing life expectancy and aging populations,Belt and Road Initiative(BRI)countries face various levels of gallbladder and biliary tract cancer(GBTC)impact.This study analyzed differences in the burden and trends of GBTC in BRI countries from 1990to 2021,providing a comprehensive understanding of geographic,temporal,and demographic variations to inform targeted public health strategies.Methods:Using the Global Burden of Disease(GBD)2021 database,we examined age-standardized incidence rate,age-standardized prevalence rate,age-standardized mortality rate,and age-standardized disability-adjusted life year rate of GBTC across 153 BRI countries.A Bayesian Age-Period-Cohort(BAPC)model analyzed temporal trends(1990-2021)and projected future burden(2035).We assessed the relationship between sociodemographic index(SDI)and GBTC burden,conducted sex-and age-stratified analyses,and evaluated geographic disparities.Results:In 2021,global age-standardized incidence rate was 2.56/100000(216768 cases),with agestandardized prevalence rate 3.69/100000(314465 cases),age-standardized mortality rate 2.04/100000(171961 deaths),and age-standardized disability-adjusted life year rate 43.2/100000(3.73 million disability-adjusted life years).Geographic analysis identified Thailand,Korea,and Chile as regions with the highest age-standardized incidence rate and age-standardized mortality rate.Age-standardized disability-adjusted life year rate correlated positively with SDI(R=0.38)across BRI countries.Between 1990and 2021,temporal trends showed age-standardized mortality rate and age-standardized disabilityadjusted life year rate declined globally(-24.09/100000and-26.25/100000),but South Asia showed increased mortality rate(+33.24/100000and+28.15/100000).Globally,age-standardized mortality rate and age-standardized disability-adjusted life year rate are projected to continue declining through 2035.Sex-and age-stratified analyses revealed that age-specific incidence,prevalence,mortality,and disabilityadjusted life year rates increased with age,peaking at 85-90years.Males had higher rates at 84-94 years,but absolute cases,deaths and disability-adjusted life years were higher in females after 70years.Conclusions:GBTC burden in BRI countries varies by regions,SDI,temporal trends,and demographic factors.While overall burden declines,addressing healthcare disparities,environmental risks,and early detection gaps is crucial in high-burden countries and populations.Strengthening collaboration among BRI countries is key to mitigating GBTC burden and advancing public health initiatives.展开更多
BACKGROUND Gallbladder and biliary tract cancer(GBTC)is a highly aggressive malignant tumor with a high fatality rate.The global incidence and mortality of GBTC continue to increase,presenting a significant challenge ...BACKGROUND Gallbladder and biliary tract cancer(GBTC)is a highly aggressive malignant tumor with a high fatality rate.The global incidence and mortality of GBTC continue to increase,presenting a significant challenge to public health.Strategies for preventing and controlling GBTC in Brazil,Russian Federation,India,China and South Africa(BRICS)countries offer valuable lessons for other developing nations.AIM To investigate GBTC burden trends in BRICS countries and perform an ageperiod-cohort(APC)analysis of Global Burden of Disease(GBD)from 1990-2021.METHODS Data on the incidences and crude incidence rates,the number of deaths and crude mortality rates,and the age-standardized incidence rate(ASIR)and agestandardized mortality rate(ASMR)of GBTC were obtained for BRICS countries from the GBD study 2021.Joinpoint regression analysis was employed to examine the trends in disease burden from 1990 to 2021.The APC model was utilized to assess the age,period,and birth cohort effects on the changes in GBTC disease burden worldwide and in the BRICS countries during the same time frame.Bayesian APC analysis was used to estimate the future burden.RESULTS The increases in incidence and deaths were 101.09%and 74.26%,respectively,compared with 1990.The ASMRs in Brazil,Russia,and China decreased,while those in India and South Africa increased.Among the BRICS countries,in most age groups in Brazil,Russia,India,and South Africa,the crude incidence and mortality rates in women were higher than those in men,whereas in China,the situation was the opposite.Joinpoint regression analysis revealed that from 1990 to 2021,the overall ASIR of gallbladder and bile duct cancer exhibited a declining trend.Although the incidence rate in China showed an increasing trend,the mortality rate exhibited a declining trend,which became more pronounced over time.CONCLUSION In BRICS countries,the number of incident cases and deaths from GBTC increased between 1990 and 2021,primarily due to rapid population growth.Nevertheless,the ASIR and ASMR declined during the same period.展开更多
AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343...AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343 biliary tract tumors resected in our single institution.Demographic characteristics, clinical data, pathology, surgical strategies, and long-term follow-up were analyzed.RESULTS: The mean age of the 19 BT-IPMN cases was 53.8 years(range: 25-74 years).The most common symptom was abdominal pain(15/19; 78.9%), followed by jaundice(7/19; 36.8%).Cholangitis was associated with most(16/19; 84.2%) of the BT-IPMN cases.Macroscopically visible mucin was detected in all 19 patients, based on original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilation(19/19; 100%) and intraluminal masses(10/19; 52.6%).Thirteen(68.4%) cases involved the intrahepatic bile duct and hilum.We performed left hepatectomy in 11/19(57.9%), right hepatectomy in 2/19(10.5%), bile duct resection in 4/19(21.1%), and pancreatoduodenectomy in 1/19(5.3%) patients.One(5.3%) patient was biopsied and received a choledochojejunostomy because of multiple tumors involving the right extrahepatic and left intrahepatic bile ducts.Histology showed malignancy in 10/19(52.6%) patients.The overall median survival was 68 mo.The benign cases showed a non-significant trend towards improved survival compared to malignant cases(68 mo vs 48 mo, P = 0.347).The patient without tumor resection died of liver failure 22 mo after palliative surgery.CONCLUSION: BT-IPMN is a rare biliary entity.Complete resection of the tumor is associated with good survival, even in patients with malignant disease.展开更多
The primary malignancies of the biliary tract, cholangio-carcinoma and gallbladder cancer, often present at an advanced stage and are marginally sensitive to radiation and chemotherapy. Accumulating evidence indicates...The primary malignancies of the biliary tract, cholangio-carcinoma and gallbladder cancer, often present at an advanced stage and are marginally sensitive to radiation and chemotherapy. Accumulating evidence indicates that molecularly targeted agents may provide new hope for improving treatment response in biliary tract carcinoma(BTC). In this article, we provide a critical review of the pathogenesis and genetic abnormalities of biliary tract neoplasms, in addition to discussing the current and emerging targeted therapeutics in BTC. Genetic studies of biliary tumors have identified the growth factors and receptors as well as their downstream signaling pathways that control the growth and survival of biliary epithelia. Target-specific monoclonal antibodies and small molecules inhibitors directed against the signaling pathways that drive BTC growth and invasion have been developed. Numerous clinical trials designed to test these agents as either monotherapy or in combination with conventional chemotherapy have been completed or are currently underway. Research focusing on understanding the molecular basis of biliary tumorigenesis will continue to identify for targeted therapy the key mutations that drive growth and invasion of biliary neoplasms. Additional strategies that have emerged for treating this malignant disease include targeting the epigenetic alterations of BTC and immunotherapy. By integrating targeted therapy with molecular profiles of biliary tumor, we hope to provide precision treatment for patients with malignant diseases of the biliary tract.展开更多
AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,wh...AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively analyzed.These patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy.In Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy.The median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improve the prognosis of this cancer.展开更多
Objective:To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver transplantation.Methods:Randomized control trials(RCTs) and comparative studies were identified ...Objective:To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver transplantation.Methods:Randomized control trials(RCTs) and comparative studies were identified by a computerized literature search of the Cochrane Library,MEDLINE(1966/1-2010/4),Scopus(1980/1-2010/4),ClinicalTrials.gov(2010/4),the Cochrane Hepato-Biliary Group Controlled Trials Register,and the Cochrane Central Register of Controlled Trials.Studies and data were extracted and assessed independently.Dichotomous outcomes were reported as odds ratios(ORs) and weighted mean difference with 95% confidence intervals(CI).Results:Five RCTs and eight comparative studies with a total of 1 608 subjects were identified.The data showed that the operation with T-tube had better outcomes for duct stenosis(P=0.01,OR=0.45,95% CI 0.24-0.85).The operations with or without T-tube had equivalent outcomes as follows:overall biliary complications(P=0.85,OR=1.15,95% CI 0.28-4.72),bile leaks(P=0.38,OR=0.75,95% CI 0.39-1.42),and cholangitis(P=0.24,OR=4.64,95% CI 0.36-60.62).These results were strengthened by the analysis of all thirteen non-randomized and randomized studies.Conclusions:Our systematic review and meta-analysis suggest that the insertion of a T-tube reduces the incidence of biliary stenosis without increasing the incidence of other biliary complications.展开更多
AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean children.METHODS:The demographic characteristics,indic...AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean children.METHODS:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were investigated.RESULTS:The mean age of the 122 patients was 8.0 ± 4.2 years.Indications were biliary pathology in 78(64.0%),pancreatic pathology in 43(35.2%),and chronic abdominal pain in one.Biliary indications included choledochal cysts in 40,choledocholithiasis in 24,suspected sclerosing cholangitis in 8,trauma in 2,and other conditions in 4.Pancreatic indications includedacute pancreatitis in 7,acute recurrent pancreatitis in 11,chronic pancreatitis in 20,trauma in 3,and pancreatic mass in 2.Of the 245 ERCPs,success rate was 98.4% and 190(77.6%) were for therapeutic purposes,including endoscopic nasal drainage(51.8%),biliary sphincterotomy(38.0%),pancreatic sphincterotomy(23.3%),stent insertion(15.1%),stone extraction(18.8%),and balloon dilatation(11.0%).Complications were postERCP pancreatitis in 16(6.5%),ileus in 23(9.4%),hemorrhage in 2(0.8%),perforation in 2(0.8%),sepsis in 1(0.4%),and impacted basket in 1(0.4%).There were no procedure-related deaths,and most complications improved under supportive care.CONCLUSION:This study showed that there is a high incidence of choledochal cyst and diagnostic and therapeutic ERCP for the management of various biliary and pancreatic diseases was safe and effective in Korean children.展开更多
BACKGROUND: Failure to diagnose and treat benign bi- liary tract disease relatively common surgical disease may cause serious consequences. Since the introduction of B- mode ultrasonography, CT, or MRI early and accur...BACKGROUND: Failure to diagnose and treat benign bi- liary tract disease relatively common surgical disease may cause serious consequences. Since the introduction of B- mode ultrasonography, CT, or MRI early and accurate diagnosis of the disease has been possible. In clinical prac- tice, however, these methods have not been adequately used. Inappropriate surgical procedures can also lead to bile duct injury or stenosis after injury, residual cholecystitis, stenosis after cholangiojejunostomy, or stenosis of the Od- di' s sphincter. But improvement of the diagnosis and treat- ment of benign biliary tract disease remains a great chal- lenge to clinicians. METHODS: A total of 149 patients with benign biliary tract disease who had received reoperation from June 1988 to June 2001 were analyzed retrospectively. Among them 95 patients (63.76%) received operation twice and 38 (25.5%) underwent 3 operations. Sixteen patients (10.74%) needed 4 or more operations. The procedures for the first opera- tion included cholecystectomy (71 patients, 47.65%), cho- lecystectomy with exploration of the common bile duct (42, 28.19%), cholangiojejunostomy (21, 14.1%), and la- paroscopic cholecystectomy (15, 10.06%). RESULTS: The causes for reoperation included residual and recurrent bile duct stones in 53 patients (35.57%), bile duct injury or stenosis after injury in 41 (27.52%), residual cho- lecystitis with or without stones in 28 (18.8%), stenosis af- ter cholangiojejunostomy in 17 (11.41%), stenosis of the Oddi's sphincter in 5 (5.35%), and others in 5 (5.35%). Four patients (2.68%) died after operation. CONCLUSIONS: To prevent reoperation for benign biliary tract diseases, the following measures should be taken to in- crease preoperative diagnostic rate, to understand condi- tions of the biliary tract by using imaging techniques and cholangiography, to examine comprehensively and careful- ly with choledochoscopy, cholangiography and B-mode ul-trasonography intraoperatively, to choose appropriate ope- rative procedures to decrease the rate of residual stones, and to decide the time for the first repair according to inju- ry type of the bile duct. Roux-en-Y hepaticojejunostomy with cholangioplasty is the best operation for the recon- struction of the biliary tract.展开更多
BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the inciden...BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures.Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications.Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated.AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT.METHODS In the electronic databases MEDLINE,PubMed,Scopus,ClinicalTrials.gov,the Cochrane Library,the Cochrane Hepato-Biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October 2020.The data of the studies before and after 2010 were separately extracted.We chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as outcomes.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the outcomes.Furthermore,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and 1.RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis.The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was observed between using and not using a T-tube before 2010.However,using a T-tube appeared to increase the incidence of overall biliary complications(P=0.049,OR=1.49,95%CI:1.00-2.22),bile leaks(P=0.048,OR=1.91,95%CI:1.01-3.64),and cholangitis(P=0.02,OR=7.21,95%CI:1.37-38.00)after 2010.A random-effects model was used in biliary strictures(after 2010),overall biliary complications(before 2010),and cholangitis(before 2010)due to their heterogeneity(I2=62.3%,85.4%,and 53.6%,respectively).In the sensitivity analysis(only RCTs included),bile leak(P=0.66)lost the significance after 2010 and a random-effects model was used in overall biliary complications(before 2010),cholangitis(before 2010),bile leaks(after 2010),and biliary strictures(after 2010)because of their heterogeneity(I2=92.2%,65.6%,50.9%,and 80.3%,respectively).CONCLUSION In conclusion,the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.展开更多
基金supported and funded by Korea University Guro Hospital(KOREA RESEARCH-DRIVEN HOSPITAL)(No.O2208261)supported by the Korea University Guro Hospital(KOREA RESEARCH-DRIVEN HOSPITAL)+1 种基金grant funded by Korea University Medicine(No.K2313971)by Korea University。
文摘Objective:This study aimed to evaluate the associations of baseline income,cumulative income exposure,and income volatility with the incidence of pancreatic and biliary tract cancers in a nationwide Korean cohort.Methods:We analyzed 3,361,091 adults aged 30-65 years who underwent the 2012 National Health Insurance Service(NHIS)health screening.Income level was derived from insurance premium data assessed over the five years preceding baseline(2008-2012)and categorized into baseline income quartiles,cumulative exposure to low or high income,and income volatility based on annual percentage changes.Incident pancreatic and biliary tract cancers were identified using diagnostic codes and the copayment reduction registry.Associations were evaluated using Cox proportional hazards models with adjustment for demographic,lifestyle,and clinical covariates,and cumulative incidence was compared using Kaplan-Meier curves.Results:During a median follow-up of 9.6 years,14,469 pancreatic cancers and 6,647 biliary tract cancers were newly diagnosed.Lower baseline income was associated with a higher risk of pancreatic and biliary tract cancers,whereas sustained high-income exposure was associated with reduced risk.Cumulative low-income exposure showed a positive linear trend with pancreatic cancer incidence.Income volatility was modestly associated with pancreatic cancer and was positively associated with biliary tract cancer in the fully adjusted model.These associations were generally consistent across subgroups,with a stronger inverse association between prolonged high-income exposure and pancreatic cancer among individuals without diabetes.Conclusions:Income level and income stability were significantly associated with the incidence of pancreatic and biliary tract cancers.Lower baseline income was associated with higher risk,whereas sustained high-income exposure was protective.Income volatility was associated with increased cancer risk,particularly for biliary tract cancer.These findings highlight the importance of incorporating income dynamics into cancer prevention strategies and addressing socioeconomic instability among vulnerable populations.
基金supported by grants from the National Natural Science Foundation of China(82170412)Shanghai Municipal Science and Technology Commission Clinical Innovation Research Special Project(23Y11905400).
文摘Perihilar cholangiocarcinoma(pCCA)and intrahepatic cholangiocarcinoma(iCCA)are highly malignant neoplasms with a 5-year overall survival rate of approximately 30%[1,2].Surgical resection remains the only potentially curative treatment,yet only one-fifth of patients are eligible for resection at initial diagnosis[3].Threedimensional(3D)reconstruction technology provides precise preoperative visualization of complex hilar anatomy,significantly enhancing surgical planning and outcomes[4].Recent advances in 3D reconstruction technology have enhanced preoperative planning by providing precise anatomical mapping of tumor-vessel relationships and biliary variations[4,5].Therefore,this report describes a case of left iCCA successfully resected with biliary reconstruction guided by 3D visualization.
文摘BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after primary surgery.Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong University.All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was uneventful.All patients were followed-up at the surgical outpatient department for six months to three years.So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.
基金Supported by National Natural Science Foundation of ChinaNo.81171789
文摘AIM: To investigate the effects of biliary tract external drainage(BTED) on intestinal barrier injury in rats with hemorrhagic shock(HS). METHODS: BTED was performed via cannula insertion into the bile duct of rats. HS was induced by drawing blood from the femoral artery at a rate of 1 m L/min until a mean arterial pressure(MAP) of 40 ± 5 mm Hg was achieved. That MAP was maintained for 60 min. A total of 99 Sprague-Dawley rats were randomized into a sham group, an HS group and an HS + BTED group. Nine rats in the sham group were sacrificed 0.5 h after surgery. Nine rats in each of the HS and HS + BTED groups were sacrificed 0.5 h, 1 h, 2 h, 4 h and 6 h after resuscitation. Plasma tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), and lipopolysaccharide(LPS) levels were analyzed using enzyme-linked immunosorbent assay. Plasma D-lactate levels were analyzed using colorimetry. The expression levels of occludin and claudin-1 in the ileum were analyzed using Western blot and immunohistochemistry. Histology of the ileumwas evaluated by hematoxylin and eosin staining. RESULTS: Plasma TNF-α levels in the HS + BTED group decreased significantly compared with the HS group at 1 h and 6 h after resuscitation(P < 0.05). Plasma IL-6 levels in the HS + BTED group decreased significantly compared with the HS group at 0.5 h, 1 h and 2 h after resuscitation(P < 0.05). Plasma D-lactate and LPS levels in the HS + BTED group decreased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). The expression levels of occludin in the HS + BTED group increased significantly compared with the HS group at 4 h and 6 h after resuscitation(P < 0.05). The expression levels of claudin-1 in the HS + BTED group increased significantly compared with the HS group at 6 h after resuscitation(P < 0.05). Phenomena of putrescence and desquamation of epithelial cells in the ileal mucosa were attenuated in the HS + BTED group. Ileal histopathologic scores in the HS + BTED group decreased significantly compared with the HS group at 2 h, 4 h and 6 h after resuscitation(P < 0.05). CONCLUSION: BTED protects against intestinal barrier injury in HS rats.
基金supported by the MISP program at Merck Sharp&Dohme Corp.,USAa grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health&Welfare,Republic of Korea(Grant Number:HR20C0025).
文摘Background:Immune checkpoint inhibitors(ICIs)are effective in a subset of patients with metastatic solid tumors.However,the patients who would benefit most from ICIs in biliary tract cancer(BTC)are still controversial.Materials and methods:We molecularly characterized tissues and blood from 32 patients with metastatic BTC treated with the ICI pembrolizumab as second-line therapy.Results:All patients had microsatellite stable(MSS)type tumors.Three of the 32 patients achieved partial response(PR),with an objective response rate(ORR)of 9.4%(95%confidence interval[CI],2.0–25.2)and nine showed stable disease(SD),exhibiting a disease control rate(DCR)of 37.5%(95%CI,21.1–56.3).For the 31 patients who had access to PD-1 ligand 1(PD-L1)combined positive score(CPS)testing(cut-off value≥1%),the ORR was not different between those who had PD-L1-positive(PD-L1+;1/11,9.1%)and PDL1-(2/20,10.0%)tumors(p=1.000).The tumor mutational burden(TMB)of PD-L1+BTC was comparable to that of PD-L1-BTC(p=0.630).TMB and any exonic somatic mutations were also not predictive of pembrolizumab response.Molecular analysis of blood and tumor samples demonstrated a relatively high natural killer(NK)cell proportion in the peripheral blood before pembrolizumab treatment in patients who achieved tumor response.Moreover,the tumors of these patients presented high enrichment scores for NK cells,antitumor cytokines,and Th1 signatures,and a low enrichment score for cancer-associated fibroblasts.Conclusions:This study shows the molecular characteristics associated with the efficacy of pembrolizumab in BTC of the MSS type.
文摘Biliary tract cancer(BTC)is a group of heterogeneous sporadic diseases,including intrahepatic,hilar,and distal cholangiocarcinoma,as well as gallbladder cancer.BTC is characterized by high invasiveness and extremely poor prognosis,with a global increased incidence due to intrahepatic cholangiocarcinoma(ICC).The 18Ffludeoxyglucose positron emission tomography(PET)computed tomography(18F-FDG PET/CT)combines glucose metabolic information(reflecting the glycolytic activity of tumor cells)with anatomical structure to assess tumor metabolic heterogeneity,systemic metastasis,and molecular characteristics noninvasively,overcoming the limitations of traditional imaging in the detection of micrometastases and recurrent lesions.18F-FDG PET/CT offers critical insights in clinical staging,therapeutic evaluation,and prognostic prediction of BTC.This article reviews research progress in this field over the past decade,with a particular focus on the advances made in the last 3 years,which have not been adequately summarized and recognized.The research paradigm in this field is shifting from qualitative to quantitative studies,and there have been significant breakthroughs in using 18F-FDG PET/CT metabolic information to predict gene expression in ICC.Radiomics and deep learning techniques have been applied to ICC for prognostic prediction and differential diagnosis.Additionally,PET/magnetic resonance imaging is increasingly demonstrating its value in this field.
文摘A clinical trial of nab-paclitaxel plus capecitabine as a first-line treatment for advanced biliary tract cancers was conducted.We analyzed the development of systemic therapy recommended by the National Comprehensive Cancer Network guidelines and the development of nab-paclitaxel combination chemotherapy for advanced biliary tract cancers(BTCs)and concluded that nab-paclitaxel plus capecitabine is a promising first-line regimen for advanced BTCs.
文摘BACKGROUND Biliary tract cancer(BTC)is a rare,aggressive malignancy with increasing inci-dence and poor prognosis.Identifying preoperative prognostic factors is crucial for effective risk-benefit assessments and patient stratification.The prognostic nutritional index(PNI),which reflects immune-inflammatory and nutritional status,has shown prognostic value in various cancers,but its significance in BTC remains unclear.AIM To assess the prognostic value of the preoperative PNI in BTC patients,with a focus on overall survival(OS)and disease-free survival(DFS).METHODS Comprehensive searches were conducted in the PubMed,EMBASE,and Web of Science databases from inception to April 2024.The primary outcomes of interest focused on the associations between the preoperative PNI and the prognosis of BTC patients,specifically OS and disease-free survival(DFS).Statistical analyses were conducted via STATA 17.0 software.RESULTS Seventeen studies encompassing 4645 patients met the inclusion criteria.Meta-analysis revealed that a low PNI was significantly associated with poorer OS[hazard ratio(HR)1.91,95%CI:1.59-2.29;P<0.001]and DFS(HR 1.93,95%CI:1.39-2.67;P<0.001).Subgroup analyses revealed consistent results across BTC subtypes(cholangiocarcinoma and gallbladder cancer)and stages(resectable and advanced).Sensitivity analyses confirmed the robustness of these findings,and no significant publication bias was detected.CONCLUSION This study demonstrated that a low preoperative PNI predicts poor OS and DFS in BTC patients,highlighting its potential as a valuable prognostic tool.Further prospective studies are needed to validate these findings and enhance BTC patient management.
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.
文摘Molecular profiling of biliary tract cancers(BTCs)has paved the way for a broader range of therapeutic options,leading to improved survival outcomes.Given the challenges of tissue evaluation in BTCs,circulating tumor DNA(ct-DNA)has emerged as a promising non-invasive biomarker for genomic profiling.Bile has been proven to be a reliable ctDNA source,demonstrating higher concordance with tumor tissue than plasma.More importantly,ctDNA provides valuable insights into both clonal evolution and treatment response,including the detection of resistance mechanisms and mutation clearance,which are often associated with disease control.Although its role in recurrence monitoring remains investigational,early studies suggest that ctDNA detection may precede radiological recurrences.This review examines recent advancements in ctDNA analysis for patients with BTC,highlighting key developments,current clinical implications,and ongoing challenges.Large-scale prospective studies are needed to validate the clinical utility of ctDNA and to support its integration into BTC management.
文摘BACKGROUND: Biliary tract injuries are mostly iatrogenic Related data are limited in developing countries. There are lessons to be learned by revisiting the clinical profiles management issues and outcome of patients referred to a tertiary care center in Sri Lanka, compared with the previous data from the same center published in 2006. Such a review is particularly relevant at a time of changing global perceptions of iatrogenic biliary injuries. This study aimed to analyze and compare the changes in the injury pattern, management and outcome following biliary tract injury in a Sri Lankan study population treated at a tertiary care center. METHODS: A retrospective analysis was made of 67 patients treated between May 2002 and February 2011. The profiles of the last 38 patients treated from October 2006 to February 2011 were compared with those of the first 29 patients treated from May 2002 to September 2006. Definitive management options included endoscopic biliary stenting, reconstructive hepaticojejunostomy with creation of gastric access loops and biliary stricture dilation. Post-treatment jaundice cholangitis and abdominal pain needing intervention were considered as treatment failures. RESULTS: In the 67 patients, 55 were women and 12 men Their mean age was 40.6 (range 19-80) years. Five patients had traumatic injuries. Thirty-seven injuries (23 during the second study period) were due to laparoscopic cholecystectomy and 25 (10 during the second study period) to open cholecystectomy The identification rate of intra-operative injury was 19% in the laparoscopic group and 8% in the open group. Bismuth typeI, II, III and IV injuries were seen in 18, 18, 15 and 12 patients, respectively. Endoscopic stenting was the definitive treatment in 20 patients. In 35 patients who had hepaticojejunostomy, 33 underwent creation of the gastric access loop. Twenty- two reconstructions were performed during the second study period. A gastric access loop was used for endotherapy in three patients with anastomotic occlusion at the site of hepaticojejunostomy. The overall outcome was satisfactory in the majority of patients. There were four injury-related deaths. CONCLUSIONS: Biliary tract injuries associated with laparoscopic cholecystectomy have become the most frequent cause of biliary injury management at our center. Although endotherapy was useful in selected patients, in the majority, surgical reconstruction with hepaticojejunostomy was required as the definitive treatment. Creation of the gastric access loop was found to be a useful adjunct in the management of hepaticojejunostomy strictures.
基金supported by a grant from the National Natural Science Foundation of China(82000618)。
文摘Background:With increasing life expectancy and aging populations,Belt and Road Initiative(BRI)countries face various levels of gallbladder and biliary tract cancer(GBTC)impact.This study analyzed differences in the burden and trends of GBTC in BRI countries from 1990to 2021,providing a comprehensive understanding of geographic,temporal,and demographic variations to inform targeted public health strategies.Methods:Using the Global Burden of Disease(GBD)2021 database,we examined age-standardized incidence rate,age-standardized prevalence rate,age-standardized mortality rate,and age-standardized disability-adjusted life year rate of GBTC across 153 BRI countries.A Bayesian Age-Period-Cohort(BAPC)model analyzed temporal trends(1990-2021)and projected future burden(2035).We assessed the relationship between sociodemographic index(SDI)and GBTC burden,conducted sex-and age-stratified analyses,and evaluated geographic disparities.Results:In 2021,global age-standardized incidence rate was 2.56/100000(216768 cases),with agestandardized prevalence rate 3.69/100000(314465 cases),age-standardized mortality rate 2.04/100000(171961 deaths),and age-standardized disability-adjusted life year rate 43.2/100000(3.73 million disability-adjusted life years).Geographic analysis identified Thailand,Korea,and Chile as regions with the highest age-standardized incidence rate and age-standardized mortality rate.Age-standardized disability-adjusted life year rate correlated positively with SDI(R=0.38)across BRI countries.Between 1990and 2021,temporal trends showed age-standardized mortality rate and age-standardized disabilityadjusted life year rate declined globally(-24.09/100000and-26.25/100000),but South Asia showed increased mortality rate(+33.24/100000and+28.15/100000).Globally,age-standardized mortality rate and age-standardized disability-adjusted life year rate are projected to continue declining through 2035.Sex-and age-stratified analyses revealed that age-specific incidence,prevalence,mortality,and disabilityadjusted life year rates increased with age,peaking at 85-90years.Males had higher rates at 84-94 years,but absolute cases,deaths and disability-adjusted life years were higher in females after 70years.Conclusions:GBTC burden in BRI countries varies by regions,SDI,temporal trends,and demographic factors.While overall burden declines,addressing healthcare disparities,environmental risks,and early detection gaps is crucial in high-burden countries and populations.Strengthening collaboration among BRI countries is key to mitigating GBTC burden and advancing public health initiatives.
基金Supported by the Key Project of Science&Technology Development Fund of Tianjin Education Commission for Higher Education,No.2024ZD023.
文摘BACKGROUND Gallbladder and biliary tract cancer(GBTC)is a highly aggressive malignant tumor with a high fatality rate.The global incidence and mortality of GBTC continue to increase,presenting a significant challenge to public health.Strategies for preventing and controlling GBTC in Brazil,Russian Federation,India,China and South Africa(BRICS)countries offer valuable lessons for other developing nations.AIM To investigate GBTC burden trends in BRICS countries and perform an ageperiod-cohort(APC)analysis of Global Burden of Disease(GBD)from 1990-2021.METHODS Data on the incidences and crude incidence rates,the number of deaths and crude mortality rates,and the age-standardized incidence rate(ASIR)and agestandardized mortality rate(ASMR)of GBTC were obtained for BRICS countries from the GBD study 2021.Joinpoint regression analysis was employed to examine the trends in disease burden from 1990 to 2021.The APC model was utilized to assess the age,period,and birth cohort effects on the changes in GBTC disease burden worldwide and in the BRICS countries during the same time frame.Bayesian APC analysis was used to estimate the future burden.RESULTS The increases in incidence and deaths were 101.09%and 74.26%,respectively,compared with 1990.The ASMRs in Brazil,Russia,and China decreased,while those in India and South Africa increased.Among the BRICS countries,in most age groups in Brazil,Russia,India,and South Africa,the crude incidence and mortality rates in women were higher than those in men,whereas in China,the situation was the opposite.Joinpoint regression analysis revealed that from 1990 to 2021,the overall ASIR of gallbladder and bile duct cancer exhibited a declining trend.Although the incidence rate in China showed an increasing trend,the mortality rate exhibited a declining trend,which became more pronounced over time.CONCLUSION In BRICS countries,the number of incident cases and deaths from GBTC increased between 1990 and 2021,primarily due to rapid population growth.Nevertheless,the ASIR and ASMR declined during the same period.
基金Supported by The Research Special Fund for Public Welfare Industry of Health,No.201202007
文摘AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343 biliary tract tumors resected in our single institution.Demographic characteristics, clinical data, pathology, surgical strategies, and long-term follow-up were analyzed.RESULTS: The mean age of the 19 BT-IPMN cases was 53.8 years(range: 25-74 years).The most common symptom was abdominal pain(15/19; 78.9%), followed by jaundice(7/19; 36.8%).Cholangitis was associated with most(16/19; 84.2%) of the BT-IPMN cases.Macroscopically visible mucin was detected in all 19 patients, based on original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilation(19/19; 100%) and intraluminal masses(10/19; 52.6%).Thirteen(68.4%) cases involved the intrahepatic bile duct and hilum.We performed left hepatectomy in 11/19(57.9%), right hepatectomy in 2/19(10.5%), bile duct resection in 4/19(21.1%), and pancreatoduodenectomy in 1/19(5.3%) patients.One(5.3%) patient was biopsied and received a choledochojejunostomy because of multiple tumors involving the right extrahepatic and left intrahepatic bile ducts.Histology showed malignancy in 10/19(52.6%) patients.The overall median survival was 68 mo.The benign cases showed a non-significant trend towards improved survival compared to malignant cases(68 mo vs 48 mo, P = 0.347).The patient without tumor resection died of liver failure 22 mo after palliative surgery.CONCLUSION: BT-IPMN is a rare biliary entity.Complete resection of the tumor is associated with good survival, even in patients with malignant disease.
文摘The primary malignancies of the biliary tract, cholangio-carcinoma and gallbladder cancer, often present at an advanced stage and are marginally sensitive to radiation and chemotherapy. Accumulating evidence indicates that molecularly targeted agents may provide new hope for improving treatment response in biliary tract carcinoma(BTC). In this article, we provide a critical review of the pathogenesis and genetic abnormalities of biliary tract neoplasms, in addition to discussing the current and emerging targeted therapeutics in BTC. Genetic studies of biliary tumors have identified the growth factors and receptors as well as their downstream signaling pathways that control the growth and survival of biliary epithelia. Target-specific monoclonal antibodies and small molecules inhibitors directed against the signaling pathways that drive BTC growth and invasion have been developed. Numerous clinical trials designed to test these agents as either monotherapy or in combination with conventional chemotherapy have been completed or are currently underway. Research focusing on understanding the molecular basis of biliary tumorigenesis will continue to identify for targeted therapy the key mutations that drive growth and invasion of biliary neoplasms. Additional strategies that have emerged for treating this malignant disease include targeting the epigenetic alterations of BTC and immunotherapy. By integrating targeted therapy with molecular profiles of biliary tumor, we hope to provide precision treatment for patients with malignant diseases of the biliary tract.
文摘AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively analyzed.These patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy.In Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy.The median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improve the prognosis of this cancer.
文摘Objective:To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver transplantation.Methods:Randomized control trials(RCTs) and comparative studies were identified by a computerized literature search of the Cochrane Library,MEDLINE(1966/1-2010/4),Scopus(1980/1-2010/4),ClinicalTrials.gov(2010/4),the Cochrane Hepato-Biliary Group Controlled Trials Register,and the Cochrane Central Register of Controlled Trials.Studies and data were extracted and assessed independently.Dichotomous outcomes were reported as odds ratios(ORs) and weighted mean difference with 95% confidence intervals(CI).Results:Five RCTs and eight comparative studies with a total of 1 608 subjects were identified.The data showed that the operation with T-tube had better outcomes for duct stenosis(P=0.01,OR=0.45,95% CI 0.24-0.85).The operations with or without T-tube had equivalent outcomes as follows:overall biliary complications(P=0.85,OR=1.15,95% CI 0.28-4.72),bile leaks(P=0.38,OR=0.75,95% CI 0.39-1.42),and cholangitis(P=0.24,OR=4.64,95% CI 0.36-60.62).These results were strengthened by the analysis of all thirteen non-randomized and randomized studies.Conclusions:Our systematic review and meta-analysis suggest that the insertion of a T-tube reduces the incidence of biliary stenosis without increasing the incidence of other biliary complications.
文摘AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean children.METHODS:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were investigated.RESULTS:The mean age of the 122 patients was 8.0 ± 4.2 years.Indications were biliary pathology in 78(64.0%),pancreatic pathology in 43(35.2%),and chronic abdominal pain in one.Biliary indications included choledochal cysts in 40,choledocholithiasis in 24,suspected sclerosing cholangitis in 8,trauma in 2,and other conditions in 4.Pancreatic indications includedacute pancreatitis in 7,acute recurrent pancreatitis in 11,chronic pancreatitis in 20,trauma in 3,and pancreatic mass in 2.Of the 245 ERCPs,success rate was 98.4% and 190(77.6%) were for therapeutic purposes,including endoscopic nasal drainage(51.8%),biliary sphincterotomy(38.0%),pancreatic sphincterotomy(23.3%),stent insertion(15.1%),stone extraction(18.8%),and balloon dilatation(11.0%).Complications were postERCP pancreatitis in 16(6.5%),ileus in 23(9.4%),hemorrhage in 2(0.8%),perforation in 2(0.8%),sepsis in 1(0.4%),and impacted basket in 1(0.4%).There were no procedure-related deaths,and most complications improved under supportive care.CONCLUSION:This study showed that there is a high incidence of choledochal cyst and diagnostic and therapeutic ERCP for the management of various biliary and pancreatic diseases was safe and effective in Korean children.
文摘BACKGROUND: Failure to diagnose and treat benign bi- liary tract disease relatively common surgical disease may cause serious consequences. Since the introduction of B- mode ultrasonography, CT, or MRI early and accurate diagnosis of the disease has been possible. In clinical prac- tice, however, these methods have not been adequately used. Inappropriate surgical procedures can also lead to bile duct injury or stenosis after injury, residual cholecystitis, stenosis after cholangiojejunostomy, or stenosis of the Od- di' s sphincter. But improvement of the diagnosis and treat- ment of benign biliary tract disease remains a great chal- lenge to clinicians. METHODS: A total of 149 patients with benign biliary tract disease who had received reoperation from June 1988 to June 2001 were analyzed retrospectively. Among them 95 patients (63.76%) received operation twice and 38 (25.5%) underwent 3 operations. Sixteen patients (10.74%) needed 4 or more operations. The procedures for the first opera- tion included cholecystectomy (71 patients, 47.65%), cho- lecystectomy with exploration of the common bile duct (42, 28.19%), cholangiojejunostomy (21, 14.1%), and la- paroscopic cholecystectomy (15, 10.06%). RESULTS: The causes for reoperation included residual and recurrent bile duct stones in 53 patients (35.57%), bile duct injury or stenosis after injury in 41 (27.52%), residual cho- lecystitis with or without stones in 28 (18.8%), stenosis af- ter cholangiojejunostomy in 17 (11.41%), stenosis of the Oddi's sphincter in 5 (5.35%), and others in 5 (5.35%). Four patients (2.68%) died after operation. CONCLUSIONS: To prevent reoperation for benign biliary tract diseases, the following measures should be taken to in- crease preoperative diagnostic rate, to understand condi- tions of the biliary tract by using imaging techniques and cholangiography, to examine comprehensively and careful- ly with choledochoscopy, cholangiography and B-mode ul-trasonography intraoperatively, to choose appropriate ope- rative procedures to decrease the rate of residual stones, and to decide the time for the first repair according to inju- ry type of the bile duct. Roux-en-Y hepaticojejunostomy with cholangioplasty is the best operation for the recon- struction of the biliary tract.
基金National Natural Science Foundation of China,No.81770491The Innovation Capacity Support Plan of Shaanxi Province,No.2020TD-040.
文摘BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation(OLT)remains a debatable question.Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures.Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications.Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated.AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT.METHODS In the electronic databases MEDLINE,PubMed,Scopus,ClinicalTrials.gov,the Cochrane Library,the Cochrane Hepato-Biliary Group Controlled Trails Register,and the Cochrane Central Register of Controlled Trials,we identified 17 studies(eight randomized controlled trials and nine comparative studies)from January 1995 to October 2020.The data of the studies before and after 2010 were separately extracted.We chose the overall biliary complications,bile leaks or fistulas,biliary strictures(anastomotic or non-anastomotic),and cholangitis as outcomes.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated to describe the results of the outcomes.Furthermore,the test for overall effect(Z)was used to test the difference between OR and 1,where P≤0.05 indicated a significant difference between OR value and 1.RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis.The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010(P=0.012,OR=0.62,95%CI:0.42-0.90),while the same benefit was not seen in studies after 2010(P=0.60,OR=0.76,95%CI:0.27-2.12).No significant difference in the incidence of overall biliary complications(P=0.37,OR=1.41,95%CI:0.66-2.98),bile leaks(P=0.89,OR=1.04,95%CI:0.63-1.70),and cholangitis(P=0.27,OR=2.00,95%CI:0.59-6.84)was observed between using and not using a T-tube before 2010.However,using a T-tube appeared to increase the incidence of overall biliary complications(P=0.049,OR=1.49,95%CI:1.00-2.22),bile leaks(P=0.048,OR=1.91,95%CI:1.01-3.64),and cholangitis(P=0.02,OR=7.21,95%CI:1.37-38.00)after 2010.A random-effects model was used in biliary strictures(after 2010),overall biliary complications(before 2010),and cholangitis(before 2010)due to their heterogeneity(I2=62.3%,85.4%,and 53.6%,respectively).In the sensitivity analysis(only RCTs included),bile leak(P=0.66)lost the significance after 2010 and a random-effects model was used in overall biliary complications(before 2010),cholangitis(before 2010),bile leaks(after 2010),and biliary strictures(after 2010)because of their heterogeneity(I2=92.2%,65.6%,50.9%,and 80.3%,respectively).CONCLUSION In conclusion,the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.
