Pub Date : 2018-08-29DOI: 10.5772/intechopen.75516
M. Massani, T. Stecca, B. Pauletti, G. Marte, C. Ruffolo, L. Bonariol, N. Bassi
Aim : The authors give a complete overview on this disease from epidemiology to treatment. Background : Cholangiocarcinoma (CCA) is an epithelial tumor with features of cholangio- cyte differentiation. Most patients suffer from a nonresectable disease since presentation and the exitus occurs within 12 months from diagnosis. Biliary epithelial carcinogenesis is a multistep process that involves the transition from hyperplasia to dysplasia to carcinoma. The clinical approach should be multidisciplinary, and the diagnosis should be considered when there is a histological finding of adenocarcinoma without any other evi dences of an extrahepatic primitive neoplasia. Surgical resection with histologically nega- tive margins is the only curative treatment. Nevertheless for unresectable patients, there are several other approaches: systemic chemotherapy is the widely used treatment, but a large proportion of patients could be suitable for liver-directed therapies. These options include transarterial chemoembolization (TACE), radioembolization (TARE), hepatic arte - rial infusion (HAI), percutaneous ablation, and external beam radiation therapy (EBRT). Conclusion : Intrahepatic cholangiocarcinoma is a relatively rare disease with a poor prog- nosis. Diagnosis is based on imaging, but pathological anatomy plays an important role. Surgery is still the gold standard treatment; nevertheless, unresectable patients could be treated in a multimodality strategy with a significant improvement in terms of survival .
{"title":"Intrahepatic Cholangiocarcinoma","authors":"M. Massani, T. Stecca, B. Pauletti, G. Marte, C. Ruffolo, L. Bonariol, N. Bassi","doi":"10.5772/intechopen.75516","DOIUrl":"https://doi.org/10.5772/intechopen.75516","url":null,"abstract":"Aim : The authors give a complete overview on this disease from epidemiology to treatment. Background : Cholangiocarcinoma (CCA) is an epithelial tumor with features of cholangio- cyte differentiation. Most patients suffer from a nonresectable disease since presentation and the exitus occurs within 12 months from diagnosis. Biliary epithelial carcinogenesis is a multistep process that involves the transition from hyperplasia to dysplasia to carcinoma. The clinical approach should be multidisciplinary, and the diagnosis should be considered when there is a histological finding of adenocarcinoma without any other evi dences of an extrahepatic primitive neoplasia. Surgical resection with histologically nega- tive margins is the only curative treatment. Nevertheless for unresectable patients, there are several other approaches: systemic chemotherapy is the widely used treatment, but a large proportion of patients could be suitable for liver-directed therapies. These options include transarterial chemoembolization (TACE), radioembolization (TARE), hepatic arte - rial infusion (HAI), percutaneous ablation, and external beam radiation therapy (EBRT). Conclusion : Intrahepatic cholangiocarcinoma is a relatively rare disease with a poor prog- nosis. Diagnosis is based on imaging, but pathological anatomy plays an important role. Surgery is still the gold standard treatment; nevertheless, unresectable patients could be treated in a multimodality strategy with a significant improvement in terms of survival .","PeriodicalId":385968,"journal":{"name":"Topics in the Surgery of the Biliary Tree","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133989952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-29DOI: 10.5772/INTECHOPEN.76328
M. Zelić, V. Lekic, Edo Bazdulj, G. Hauser
Injuries of the biliary system are rare. They can broadly be divided into traumatic biliary injuries and iatrogenic biliary injuries. Former are usually part of associated abdominal trauma, blunt or penetrating, and latter are consequence of surgical, endoscopic or inva - sive radiological diagnostic or therapeutic procedures done in various liver, pancreatic or disorders or the part of upper gastrointestinal system. They occur more commonly than traumatic injuries but still are rare. Those injuries represent important aspect in healthcare system because of their complexity and diversity in management, associated morbidity and mortality and expenditure in healthcare systems. This chapter will put focus on those injuries, including their classification, etiology and mechanism of occur - rence, clinical presentation, diagnosis, treatment options, postoperative complications, and, when iatrogenic injuries are concerned, methods for prevention of those injuries. avoid during procedures. One of the most is Delphi consensus.
{"title":"Biliary Tract Injuries","authors":"M. Zelić, V. Lekic, Edo Bazdulj, G. Hauser","doi":"10.5772/INTECHOPEN.76328","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76328","url":null,"abstract":"Injuries of the biliary system are rare. They can broadly be divided into traumatic biliary injuries and iatrogenic biliary injuries. Former are usually part of associated abdominal trauma, blunt or penetrating, and latter are consequence of surgical, endoscopic or inva - sive radiological diagnostic or therapeutic procedures done in various liver, pancreatic or disorders or the part of upper gastrointestinal system. They occur more commonly than traumatic injuries but still are rare. Those injuries represent important aspect in healthcare system because of their complexity and diversity in management, associated morbidity and mortality and expenditure in healthcare systems. This chapter will put focus on those injuries, including their classification, etiology and mechanism of occur - rence, clinical presentation, diagnosis, treatment options, postoperative complications, and, when iatrogenic injuries are concerned, methods for prevention of those injuries. avoid during procedures. One of the most is Delphi consensus.","PeriodicalId":385968,"journal":{"name":"Topics in the Surgery of the Biliary Tree","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129357234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-29DOI: 10.5772/INTECHOPEN.77118
Dzeina Mezale, Ilze Strumfa, Andrejs Vanags, G. Bahs, B. Štrumfs, Arturs Silovs, R. Riekstins, J. Gardovskis
Mucinous cystic neoplasms of the liver and extrahepatic biliary tree have recently been re-defined by WHO as epithelial cystic tumours with ovarian-type mesenchymal stroma. Correct recognition of these tumours can be difficult because of their rarity and, conse - quently, lack of awareness by the medical team. Radiological evaluation, including ultra -sonography, computed tomography, magnetic resonance imaging and, upon necessity, positron emission tomography, can yield the correct diagnosis. Radical surgical resection with tumour-free margins is the mainstay of treatment. Adequate treatment approach can be very rewarding, bringing prolonged survival. Here we discuss the up-to-date concepts of definition and classification, theoretical views on tumour origin along with practical issues of clinical presentation, diagnostics, treatment and prognosis. Bile duct compression [10] or invasion can lead to obstructive jaundice and predispose to ascending infection resulting in cholangitis. If the tumour contents are discharged into bile ducts, mucobilia is possible. Bleeding to biliary ways results in haemobilia [ 51 ]. Biliary symp toms are seen in 35% of patients with benign tumours referred to as cystadenomas by WHO classification, 2000 [10] and can be responsible for acute presentation or intermittent course, in addition to the more classical slowly progressing clinical picture.
{"title":"Mucinous Cystic Neoplasms of the Liver and Extrahepatic Biliary Tract","authors":"Dzeina Mezale, Ilze Strumfa, Andrejs Vanags, G. Bahs, B. Štrumfs, Arturs Silovs, R. Riekstins, J. Gardovskis","doi":"10.5772/INTECHOPEN.77118","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77118","url":null,"abstract":"Mucinous cystic neoplasms of the liver and extrahepatic biliary tree have recently been re-defined by WHO as epithelial cystic tumours with ovarian-type mesenchymal stroma. Correct recognition of these tumours can be difficult because of their rarity and, conse - quently, lack of awareness by the medical team. Radiological evaluation, including ultra -sonography, computed tomography, magnetic resonance imaging and, upon necessity, positron emission tomography, can yield the correct diagnosis. Radical surgical resection with tumour-free margins is the mainstay of treatment. Adequate treatment approach can be very rewarding, bringing prolonged survival. Here we discuss the up-to-date concepts of definition and classification, theoretical views on tumour origin along with practical issues of clinical presentation, diagnostics, treatment and prognosis. Bile duct compression [10] or invasion can lead to obstructive jaundice and predispose to ascending infection resulting in cholangitis. If the tumour contents are discharged into bile ducts, mucobilia is possible. Bleeding to biliary ways results in haemobilia [ 51 ]. Biliary symp toms are seen in 35% of patients with benign tumours referred to as cystadenomas by WHO classification, 2000 [10] and can be responsible for acute presentation or intermittent course, in addition to the more classical slowly progressing clinical picture.","PeriodicalId":385968,"journal":{"name":"Topics in the Surgery of the Biliary Tree","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123329777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-29DOI: 10.5772/INTECHOPEN.77335
H. Abdeldayem
Biliary stones are formed as a result of failure to maintain biliary solutes (primarily, cholesterol and calcium salts) in a soluble state. The pathogenesis is multifactorial and involves cholesterol supersaturation, crystal nucleation, and gallbladder dysmotility. The vast majority of patients are asymptomatic, often discovered at laparotomy or during abdominal imaging. Over time, asymptomatic gallstones can progress to symptomatic disease. Prophylactic cholecystectomy is not generally indicated in patients with asymptomatic gallstones. Prophylactic cholecystectomy is considered for children with gallstones, patients with sickle cell disease (as cholecystitis can precipitate a crisis with substantial operative risks), and large gallstones (>2.5 cm), porcelain gallbladder (calcified gallbladder wall). Acute cholecystitis results from a stone impaction at the gallbladder-cystic duct junction. The extent and the progression of inflammation are related to the duration and degree of obstruction. In severe cases, this process can lead to ischemia and necrosis of the gallbladder wall. More frequently, the gallstone is dislodged, and the inflammation gradually resolves. Intrahepatic stones are more prevalent in Asia. They are associated with prolonged partial BD obstruction, as in sclerosing cholangitis, benign and malignant biliary strictures, choledochal cysts, and biliary parasites. Mirizzi syndrome is a form of obstructive jaundice, first described by Mirizzi in 1948, caused
{"title":"Introductory Chapter: Biliary Tree","authors":"H. Abdeldayem","doi":"10.5772/INTECHOPEN.77335","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77335","url":null,"abstract":"Biliary stones are formed as a result of failure to maintain biliary solutes (primarily, cholesterol and calcium salts) in a soluble state. The pathogenesis is multifactorial and involves cholesterol supersaturation, crystal nucleation, and gallbladder dysmotility. The vast majority of patients are asymptomatic, often discovered at laparotomy or during abdominal imaging. Over time, asymptomatic gallstones can progress to symptomatic disease. Prophylactic cholecystectomy is not generally indicated in patients with asymptomatic gallstones. Prophylactic cholecystectomy is considered for children with gallstones, patients with sickle cell disease (as cholecystitis can precipitate a crisis with substantial operative risks), and large gallstones (>2.5 cm), porcelain gallbladder (calcified gallbladder wall). Acute cholecystitis results from a stone impaction at the gallbladder-cystic duct junction. The extent and the progression of inflammation are related to the duration and degree of obstruction. In severe cases, this process can lead to ischemia and necrosis of the gallbladder wall. More frequently, the gallstone is dislodged, and the inflammation gradually resolves. Intrahepatic stones are more prevalent in Asia. They are associated with prolonged partial BD obstruction, as in sclerosing cholangitis, benign and malignant biliary strictures, choledochal cysts, and biliary parasites. Mirizzi syndrome is a form of obstructive jaundice, first described by Mirizzi in 1948, caused","PeriodicalId":385968,"journal":{"name":"Topics in the Surgery of the Biliary Tree","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122968707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-29DOI: 10.5772/INTECHOPEN.75634
J. Rodriguez-Pascual, M. Babbitt, E. Sanz, A. Cubillo
Biliary tract carcinomas are aggressive tumors that arise from epithelial cells of bile ducts. They present several difficulties in their clinical management. A late initial diagnosis (fre quently in the form of locally advanced disease), jaundice, cholangitis, or poor perfor- mance status of patients are some of the medical issues that arise in this setting. Another clinical limitation is the lack of robust evidence for many of the standard procedures in this particular scenario. Biliary tumors are lethal tumors, and most of them present in the form of advanced disease or during late evolution. However, we are witnessing some exciting changes in clinical management of tumors of the biliary tract, such as the development of new radiological techniques and novel interventional radiology procedures, the emergence of new radiotherapy modalities, the establishment of standardized chemotherapy regimens, the advance in molecular knowledge, and the development of new treatments directed against therapeutic targets. On the other hand, the most important step for advancing the treatment of these complex diseases is the appearance of multi- disciplinary management teams integrating qualified specialists to resolve appropriate treatment challenges. In this chapter, we summarize the most relevant advances in clini- cal management and new oncologic treatment in biliary tract carcinomas.
{"title":"Multidisciplinary Approach of Malignant Tumors of the Biliary Tree","authors":"J. Rodriguez-Pascual, M. Babbitt, E. Sanz, A. Cubillo","doi":"10.5772/INTECHOPEN.75634","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.75634","url":null,"abstract":"Biliary tract carcinomas are aggressive tumors that arise from epithelial cells of bile ducts. They present several difficulties in their clinical management. A late initial diagnosis (fre quently in the form of locally advanced disease), jaundice, cholangitis, or poor perfor- mance status of patients are some of the medical issues that arise in this setting. Another clinical limitation is the lack of robust evidence for many of the standard procedures in this particular scenario. Biliary tumors are lethal tumors, and most of them present in the form of advanced disease or during late evolution. However, we are witnessing some exciting changes in clinical management of tumors of the biliary tract, such as the development of new radiological techniques and novel interventional radiology procedures, the emergence of new radiotherapy modalities, the establishment of standardized chemotherapy regimens, the advance in molecular knowledge, and the development of new treatments directed against therapeutic targets. On the other hand, the most important step for advancing the treatment of these complex diseases is the appearance of multi- disciplinary management teams integrating qualified specialists to resolve appropriate treatment challenges. In this chapter, we summarize the most relevant advances in clini- cal management and new oncologic treatment in biliary tract carcinomas.","PeriodicalId":385968,"journal":{"name":"Topics in the Surgery of the Biliary Tree","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132283686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-10DOI: 10.5772/INTECHOPEN.76134
J. Jo, S. Song
Cholangiocarcinoma is a relatively rare form of gastroenterological cancer that divided into intrahepatic, perihilar, and distal bile duct cancer. Approximately, 10,000 new cases are diagnosed annually in the United States, and a 5-year survival rate is below 20%. While only surgical resection can provide a cure, most of cholangiocarcinomas are detected at inoperable stage and associated with poor prognosis. Moreover, cholangiocarcinoma has a high recurrence rate, even after curative surgery. Therefore, chemotherapy has an important role in the treatment of patients with cholangiocarcinoma. International efforts by physicians and researchers are revealing genetic factors of cholangiocarcinoma progression, which will identify early diagnostic markers and novel therapeutic targets. In this chapter, current strategies of adjuvant, neoadjuvant, and palliative chemotherapy will be discussed, as well as expectant future therapeutic targets and development of individualized therapies.
{"title":"Chemotherapy of Cholangiocarcinoma: Current Management and Future Directions","authors":"J. Jo, S. Song","doi":"10.5772/INTECHOPEN.76134","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76134","url":null,"abstract":"Cholangiocarcinoma is a relatively rare form of gastroenterological cancer that divided into intrahepatic, perihilar, and distal bile duct cancer. Approximately, 10,000 new cases are diagnosed annually in the United States, and a 5-year survival rate is below 20%. While only surgical resection can provide a cure, most of cholangiocarcinomas are detected at inoperable stage and associated with poor prognosis. Moreover, cholangiocarcinoma has a high recurrence rate, even after curative surgery. Therefore, chemotherapy has an important role in the treatment of patients with cholangiocarcinoma. International efforts by physicians and researchers are revealing genetic factors of cholangiocarcinoma progression, which will identify early diagnostic markers and novel therapeutic targets. In this chapter, current strategies of adjuvant, neoadjuvant, and palliative chemotherapy will be discussed, as well as expectant future therapeutic targets and development of individualized therapies.","PeriodicalId":385968,"journal":{"name":"Topics in the Surgery of the Biliary Tree","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114315448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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