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Jon Arne Soreide - One of the best experts on this subject based on the ideXlab platform.
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Bile Duct Cyst as precursor to biliary tract cancer
Annals of Surgical Oncology, 2007Co-Authors: Kjetil Soreide, Jon Arne SoreideAbstract:Bile Duct Cysts (BDC) are rare, of uncertain origin, and occur most often in young females of Asian descent. Increasingly, BDCs are reported in the Western population, often with coexistent biliary tract cancer. The PubMed and Medline literature databases were searched for pertinent publications regarding the clinical association and molecular biological development of cancerogenesis in BDC. Reports from the last two decades were emphasized. Cancer is found in 10–30% of adults with BDC. The cancer-risk is low in childhood (<1% in the first decade), and shows a clear increase with age. Cholangiocarcinoma is the most common malignancy in BDC, and represents a 20- to 30-fold risk compared to the general population. The mean age of malignancy in BDC is 32 years (about two decades earlier than in the general population). Type I and type IV Cysts show a higher cancer incidence, even after Cyst excision. Pathological findings strongly suggest a hyperplasia-dysplasia-carcinoma sequence in carcinogenesis of pancreatico-biliary maljunction (PBM). Reflux of pancreatic enzymes, amylase, Bile stasis, and an increased intraDuctal concentration of Bile acids contribute to proliferative activity of Bile acids in BDC. While microsatellite instability, k-ras mutations, expression of COX-2 and bcl-2, and increased telomerase activity seem to occur early; involvement of cyclin D 1 , β-catenin, DPC-4/Smad4 and p53 appear later in carcinogenesis. Increased molecular knowledge substantiates the clinically related cancer-risk in BDC. Surgery remains the golden standard for treatment, relieves patients from associated complications, and interrupts the cancerous potential in BDC.
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Bile Duct Cyst as precursor to biliary tract cancer
Annals of Surgical Oncology, 2007Co-Authors: Kjetil Soreide, Jon Arne SoreideAbstract:Background Bile Duct Cysts (BDC) are rare, of uncertain origin, and occur most often in young females of Asian descent. Increasingly, BDCs are reported in the Western population, often with coexistent biliary tract cancer.
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Bile Duct Cyst as precursor to biliary tract cancer.
Annals of surgical oncology, 2006Co-Authors: Kjetil Soreide, Jon Arne SoreideAbstract:Bile Duct Cysts (BDC) are rare, of uncertain origin, and occur most often in young females of Asian descent. Increasingly, BDCs are reported in the Western population, often with coexistent biliary tract cancer. The PubMed and Medline literature databases were searched for pertinent publications regarding the clinical association and molecular biological development of cancerogenesis in BDC. Reports from the last two decades were emphasized. Cancer is found in 10–30% of adults with BDC. The cancer-risk is low in childhood (
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Bile Duct Cysts in adults.
The British journal of surgery, 2004Co-Authors: Kjetil Soreide, Hartwig Kørner, J. Havnen, Jon Arne SoreideAbstract:Background: Bile Duct Cysts are rare and of uncertain origin. Most have been reported in young females of Asian descent, but an increasing number have occurred in Western adults. Methods: A Medline literature search was performed to locate articles on the pathophysiological concepts, clinical behaviour and management controversies pertaining to Bile Duct Cysts in adults. Emphasis was placed on reports from the past two decades. Results and conclusion: An increasing rate of occurrence of Bile Duct Cyst is reported in adults. Type IV Cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the Cysts and to reduce the significant risk of malignant change within the biliary tree. Complete Cyst resection, choleCystectomy and Roux-en- hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V Cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Jia-hong Dong - One of the best experts on this subject based on the ideXlab platform.
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Research Article Role of the Surgical Method in Development of Postoperative Cholangiocarcinoma in Todani Type IV Bile Duct Cysts
2016Co-Authors: Hong-tian Xia, Tao Yang, Bin Liang, Jian-ping Zeng, Jia-hong DongAbstract:Copyright © 2015 Hong-tian Xia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproDuction in any medium, provided the original work is properly cited. Background. Our purpose was to investigate the association between the surgical approach for Todani type IV Cysts and subsequent malignancy rate. Methods. The records of patients who received Cyst excision from 1994 to 2013 were analyzed retrospectively for the following data: demographics, presenting symptoms, postoperative outcomes, malignant transformation, and follow-up reexaminations, including imaging, laboratory, and tumor marker tests. Results. Seven of the 196 patients initially treated at our hospital developed postoperative biliary malignancy, and the surgical approaches were extrahepatic Bile Duct Cyst resection combined with hilar cholangioplasty and Roux-en-Y Cystojejunostomy (n = 5), and intra- and extrahepatic Bile Duct Cyst resection and Roux-en-Y hepaticojejunostomy (n = 2). The overall malignancy rate was 3.6 % (7/196). Forty-eight patients initially treated at other hospitals developed malignancy postoperatively: 15 (31.2%) remained untreated and 33 (68.8%) had undergone incomplete resection procedures. Because Todani type IV Cysts were seen in 268 patients, the postoperative malignancy rate of this group of patients was 12.3 % (33/268). Conclusions. Radical resection of both intra- and extrahepatic Cysts combined with hepatic resection and Roux-en-Y hepaticojejunostomy is associated with a reduced risk of subsequent cancer development. Procedures in which radical Cyst excision is not performed are associated with a greater risk of subsequent malignancy. 1
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Role of the Surgical Method in Development of Postoperative Cholangiocarcinoma in Todani Type IV Bile Duct Cysts
Gastroenterology research and practice, 2015Co-Authors: Hong-tian Xia, Tao Yang, Bin Liang, Jian-ping Zeng, Jia-hong DongAbstract:Background. Our purpose was to investigate the association between the surgical approach for Todani type IV Cysts and subsequent malignancy rate. Methods. The records of patients who received Cyst excision from 1994 to 2013 were analyzed retrospectively for the following data: demographics, presenting symptoms, postoperative outcomes, malignant transformation, and follow-up reexaminations, including imaging, laboratory, and tumor marker tests. Results. Seven of the 196 patients initially treated at our hospital developed postoperative biliary malignancy, and the surgical approaches were extrahepatic Bile Duct Cyst resection combined with hilar cholangioplasty and Roux-en-Y Cystojejunostomy ( ), and intra- and extrahepatic Bile Duct Cyst resection and Roux-en-Y hepaticojejunostomy ( ). The overall malignancy rate was 3.6% (7/196). Forty-eight patients initially treated at other hospitals developed malignancy postoperatively: 15 (31.2%) remained untreated and 33 (68.8%) had undergone incomplete resection procedures. Because Todani type IV Cysts were seen in 268 patients, the postoperative malignancy rate of this group of patients was 12.3% (33/268). Conclusions. Radical resection of both intra- and extrahepatic Cysts combined with hepatic resection and Roux-en-Y hepaticojejunostomy is associated with a reduced risk of subsequent cancer development. Procedures in which radical Cyst excision is not performed are associated with a greater risk of subsequent malignancy.
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Aggressive hepatectomy for the curative treatment of bilobar involvement of type IV-A Bile Duct Cyst.
Annals of surgery, 2013Co-Authors: Jia-hong Dong, Bin Liang, Shi-zhong Yang, Xia Hongtian, Wei-dong Duan, Zhi-qiang HuangAbstract:OBJECTIVE To analyze the risk and benefit of aggressive hepatectomy for the curative treatment of bilobar Bile Duct Cysts (BDCs) of type IV-A. BACKGROUND Conventional surgical treatment of bilobar BDCs of type IV-A is extrahepatic Cyst excision, followed by biliodigestive anastomosis. The role of hepatectomy in the treatment of bilobar BDCs remains unclear. METHODS Between January 2006 and December 2011, a total of 28 patients with bilobar BDCs who underwent an aggressive hepatectomy were identified from a prospective database. Perioperative and long-term outcomes in these patients were compared with 18 patients with bilobar BDCs who received conventional surgical treatment. RESULTS Patient characteristics such as age, sex, and clinical presentation were similar in both groups. Cystic dilatation of Bile Ducts was curatively resected in all 28 patients undergoing aggressive hepatectomy. Postoperative morbidity (57.1% vs 22.2%, P = 0.020), but not mortality (3.6% vs 0%, P = 1.000), in patients who underwent aggressive hepatectomy was significantly increased when compared with those who received conventional surgical treatment. Clearance rate of intrahepatic stones was significantly higher after aggressive hepatectomy than that after conventional surgical treatment (100.0% vs 45.5%, P < 0.001). Twenty-seven of 28 patients (96.4%), except 1 patient who met in-hospital death, achieved a symptom-free status after aggressive hepatectomy during a mean follow-up of 31 months. In contrast, during a mean follow-up of 37 months, 7 patients (38.9%, 7/18) remained free of biliary symptoms after conventional surgical treatment. The long-term outcomes between aggressive hepatectomy and conventional surgical treatment were significantly different (P < 0.001). In addition, no malignant transformation occurred after aggressive hepatectomy. However, intrahepatic cholangiocarcinoma has developed in the remnant BDC in 2 of 18 patients (11.1%) receiving conventional surgical treatment during follow-up. CONCLUSIONS Aggressive hepatectomy, a challenging procedure, provides an efficient treatment option for some selected patients with bilobar BDCs of type IV-A. The role of aggressive hepatectomy in the curative treatment of bilobar BDCs of type IV-A should be paid particular attention in the future.
Kjetil Soreide - One of the best experts on this subject based on the ideXlab platform.
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Bile Duct Cyst as precursor to biliary tract cancer
Annals of Surgical Oncology, 2007Co-Authors: Kjetil Soreide, Jon Arne SoreideAbstract:Bile Duct Cysts (BDC) are rare, of uncertain origin, and occur most often in young females of Asian descent. Increasingly, BDCs are reported in the Western population, often with coexistent biliary tract cancer. The PubMed and Medline literature databases were searched for pertinent publications regarding the clinical association and molecular biological development of cancerogenesis in BDC. Reports from the last two decades were emphasized. Cancer is found in 10–30% of adults with BDC. The cancer-risk is low in childhood (<1% in the first decade), and shows a clear increase with age. Cholangiocarcinoma is the most common malignancy in BDC, and represents a 20- to 30-fold risk compared to the general population. The mean age of malignancy in BDC is 32 years (about two decades earlier than in the general population). Type I and type IV Cysts show a higher cancer incidence, even after Cyst excision. Pathological findings strongly suggest a hyperplasia-dysplasia-carcinoma sequence in carcinogenesis of pancreatico-biliary maljunction (PBM). Reflux of pancreatic enzymes, amylase, Bile stasis, and an increased intraDuctal concentration of Bile acids contribute to proliferative activity of Bile acids in BDC. While microsatellite instability, k-ras mutations, expression of COX-2 and bcl-2, and increased telomerase activity seem to occur early; involvement of cyclin D 1 , β-catenin, DPC-4/Smad4 and p53 appear later in carcinogenesis. Increased molecular knowledge substantiates the clinically related cancer-risk in BDC. Surgery remains the golden standard for treatment, relieves patients from associated complications, and interrupts the cancerous potential in BDC.
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Bile Duct Cyst as precursor to biliary tract cancer
Annals of Surgical Oncology, 2007Co-Authors: Kjetil Soreide, Jon Arne SoreideAbstract:Background Bile Duct Cysts (BDC) are rare, of uncertain origin, and occur most often in young females of Asian descent. Increasingly, BDCs are reported in the Western population, often with coexistent biliary tract cancer.
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Bile Duct Cyst as precursor to biliary tract cancer.
Annals of surgical oncology, 2006Co-Authors: Kjetil Soreide, Jon Arne SoreideAbstract:Bile Duct Cysts (BDC) are rare, of uncertain origin, and occur most often in young females of Asian descent. Increasingly, BDCs are reported in the Western population, often with coexistent biliary tract cancer. The PubMed and Medline literature databases were searched for pertinent publications regarding the clinical association and molecular biological development of cancerogenesis in BDC. Reports from the last two decades were emphasized. Cancer is found in 10–30% of adults with BDC. The cancer-risk is low in childhood (
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Bile Duct Cysts in adults.
The British journal of surgery, 2004Co-Authors: Kjetil Soreide, Hartwig Kørner, J. Havnen, Jon Arne SoreideAbstract:Background: Bile Duct Cysts are rare and of uncertain origin. Most have been reported in young females of Asian descent, but an increasing number have occurred in Western adults. Methods: A Medline literature search was performed to locate articles on the pathophysiological concepts, clinical behaviour and management controversies pertaining to Bile Duct Cysts in adults. Emphasis was placed on reports from the past two decades. Results and conclusion: An increasing rate of occurrence of Bile Duct Cyst is reported in adults. Type IV Cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the Cysts and to reduce the significant risk of malignant change within the biliary tree. Complete Cyst resection, choleCystectomy and Roux-en- hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V Cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Bin Liang - One of the best experts on this subject based on the ideXlab platform.
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Research Article Role of the Surgical Method in Development of Postoperative Cholangiocarcinoma in Todani Type IV Bile Duct Cysts
2016Co-Authors: Hong-tian Xia, Tao Yang, Bin Liang, Jian-ping Zeng, Jia-hong DongAbstract:Copyright © 2015 Hong-tian Xia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproDuction in any medium, provided the original work is properly cited. Background. Our purpose was to investigate the association between the surgical approach for Todani type IV Cysts and subsequent malignancy rate. Methods. The records of patients who received Cyst excision from 1994 to 2013 were analyzed retrospectively for the following data: demographics, presenting symptoms, postoperative outcomes, malignant transformation, and follow-up reexaminations, including imaging, laboratory, and tumor marker tests. Results. Seven of the 196 patients initially treated at our hospital developed postoperative biliary malignancy, and the surgical approaches were extrahepatic Bile Duct Cyst resection combined with hilar cholangioplasty and Roux-en-Y Cystojejunostomy (n = 5), and intra- and extrahepatic Bile Duct Cyst resection and Roux-en-Y hepaticojejunostomy (n = 2). The overall malignancy rate was 3.6 % (7/196). Forty-eight patients initially treated at other hospitals developed malignancy postoperatively: 15 (31.2%) remained untreated and 33 (68.8%) had undergone incomplete resection procedures. Because Todani type IV Cysts were seen in 268 patients, the postoperative malignancy rate of this group of patients was 12.3 % (33/268). Conclusions. Radical resection of both intra- and extrahepatic Cysts combined with hepatic resection and Roux-en-Y hepaticojejunostomy is associated with a reduced risk of subsequent cancer development. Procedures in which radical Cyst excision is not performed are associated with a greater risk of subsequent malignancy. 1
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Role of the Surgical Method in Development of Postoperative Cholangiocarcinoma in Todani Type IV Bile Duct Cysts
Gastroenterology research and practice, 2015Co-Authors: Hong-tian Xia, Tao Yang, Bin Liang, Jian-ping Zeng, Jia-hong DongAbstract:Background. Our purpose was to investigate the association between the surgical approach for Todani type IV Cysts and subsequent malignancy rate. Methods. The records of patients who received Cyst excision from 1994 to 2013 were analyzed retrospectively for the following data: demographics, presenting symptoms, postoperative outcomes, malignant transformation, and follow-up reexaminations, including imaging, laboratory, and tumor marker tests. Results. Seven of the 196 patients initially treated at our hospital developed postoperative biliary malignancy, and the surgical approaches were extrahepatic Bile Duct Cyst resection combined with hilar cholangioplasty and Roux-en-Y Cystojejunostomy ( ), and intra- and extrahepatic Bile Duct Cyst resection and Roux-en-Y hepaticojejunostomy ( ). The overall malignancy rate was 3.6% (7/196). Forty-eight patients initially treated at other hospitals developed malignancy postoperatively: 15 (31.2%) remained untreated and 33 (68.8%) had undergone incomplete resection procedures. Because Todani type IV Cysts were seen in 268 patients, the postoperative malignancy rate of this group of patients was 12.3% (33/268). Conclusions. Radical resection of both intra- and extrahepatic Cysts combined with hepatic resection and Roux-en-Y hepaticojejunostomy is associated with a reduced risk of subsequent cancer development. Procedures in which radical Cyst excision is not performed are associated with a greater risk of subsequent malignancy.
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Aggressive hepatectomy for the curative treatment of bilobar involvement of type IV-A Bile Duct Cyst.
Annals of surgery, 2013Co-Authors: Jia-hong Dong, Bin Liang, Shi-zhong Yang, Xia Hongtian, Wei-dong Duan, Zhi-qiang HuangAbstract:OBJECTIVE To analyze the risk and benefit of aggressive hepatectomy for the curative treatment of bilobar Bile Duct Cysts (BDCs) of type IV-A. BACKGROUND Conventional surgical treatment of bilobar BDCs of type IV-A is extrahepatic Cyst excision, followed by biliodigestive anastomosis. The role of hepatectomy in the treatment of bilobar BDCs remains unclear. METHODS Between January 2006 and December 2011, a total of 28 patients with bilobar BDCs who underwent an aggressive hepatectomy were identified from a prospective database. Perioperative and long-term outcomes in these patients were compared with 18 patients with bilobar BDCs who received conventional surgical treatment. RESULTS Patient characteristics such as age, sex, and clinical presentation were similar in both groups. Cystic dilatation of Bile Ducts was curatively resected in all 28 patients undergoing aggressive hepatectomy. Postoperative morbidity (57.1% vs 22.2%, P = 0.020), but not mortality (3.6% vs 0%, P = 1.000), in patients who underwent aggressive hepatectomy was significantly increased when compared with those who received conventional surgical treatment. Clearance rate of intrahepatic stones was significantly higher after aggressive hepatectomy than that after conventional surgical treatment (100.0% vs 45.5%, P < 0.001). Twenty-seven of 28 patients (96.4%), except 1 patient who met in-hospital death, achieved a symptom-free status after aggressive hepatectomy during a mean follow-up of 31 months. In contrast, during a mean follow-up of 37 months, 7 patients (38.9%, 7/18) remained free of biliary symptoms after conventional surgical treatment. The long-term outcomes between aggressive hepatectomy and conventional surgical treatment were significantly different (P < 0.001). In addition, no malignant transformation occurred after aggressive hepatectomy. However, intrahepatic cholangiocarcinoma has developed in the remnant BDC in 2 of 18 patients (11.1%) receiving conventional surgical treatment during follow-up. CONCLUSIONS Aggressive hepatectomy, a challenging procedure, provides an efficient treatment option for some selected patients with bilobar BDCs of type IV-A. The role of aggressive hepatectomy in the curative treatment of bilobar BDCs of type IV-A should be paid particular attention in the future.
Hong-tian Xia - One of the best experts on this subject based on the ideXlab platform.
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Research Article Role of the Surgical Method in Development of Postoperative Cholangiocarcinoma in Todani Type IV Bile Duct Cysts
2016Co-Authors: Hong-tian Xia, Tao Yang, Bin Liang, Jian-ping Zeng, Jia-hong DongAbstract:Copyright © 2015 Hong-tian Xia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproDuction in any medium, provided the original work is properly cited. Background. Our purpose was to investigate the association between the surgical approach for Todani type IV Cysts and subsequent malignancy rate. Methods. The records of patients who received Cyst excision from 1994 to 2013 were analyzed retrospectively for the following data: demographics, presenting symptoms, postoperative outcomes, malignant transformation, and follow-up reexaminations, including imaging, laboratory, and tumor marker tests. Results. Seven of the 196 patients initially treated at our hospital developed postoperative biliary malignancy, and the surgical approaches were extrahepatic Bile Duct Cyst resection combined with hilar cholangioplasty and Roux-en-Y Cystojejunostomy (n = 5), and intra- and extrahepatic Bile Duct Cyst resection and Roux-en-Y hepaticojejunostomy (n = 2). The overall malignancy rate was 3.6 % (7/196). Forty-eight patients initially treated at other hospitals developed malignancy postoperatively: 15 (31.2%) remained untreated and 33 (68.8%) had undergone incomplete resection procedures. Because Todani type IV Cysts were seen in 268 patients, the postoperative malignancy rate of this group of patients was 12.3 % (33/268). Conclusions. Radical resection of both intra- and extrahepatic Cysts combined with hepatic resection and Roux-en-Y hepaticojejunostomy is associated with a reduced risk of subsequent cancer development. Procedures in which radical Cyst excision is not performed are associated with a greater risk of subsequent malignancy. 1
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Role of the Surgical Method in Development of Postoperative Cholangiocarcinoma in Todani Type IV Bile Duct Cysts
Gastroenterology research and practice, 2015Co-Authors: Hong-tian Xia, Tao Yang, Bin Liang, Jian-ping Zeng, Jia-hong DongAbstract:Background. Our purpose was to investigate the association between the surgical approach for Todani type IV Cysts and subsequent malignancy rate. Methods. The records of patients who received Cyst excision from 1994 to 2013 were analyzed retrospectively for the following data: demographics, presenting symptoms, postoperative outcomes, malignant transformation, and follow-up reexaminations, including imaging, laboratory, and tumor marker tests. Results. Seven of the 196 patients initially treated at our hospital developed postoperative biliary malignancy, and the surgical approaches were extrahepatic Bile Duct Cyst resection combined with hilar cholangioplasty and Roux-en-Y Cystojejunostomy ( ), and intra- and extrahepatic Bile Duct Cyst resection and Roux-en-Y hepaticojejunostomy ( ). The overall malignancy rate was 3.6% (7/196). Forty-eight patients initially treated at other hospitals developed malignancy postoperatively: 15 (31.2%) remained untreated and 33 (68.8%) had undergone incomplete resection procedures. Because Todani type IV Cysts were seen in 268 patients, the postoperative malignancy rate of this group of patients was 12.3% (33/268). Conclusions. Radical resection of both intra- and extrahepatic Cysts combined with hepatic resection and Roux-en-Y hepaticojejunostomy is associated with a reduced risk of subsequent cancer development. Procedures in which radical Cyst excision is not performed are associated with a greater risk of subsequent malignancy.