Wu You-min, Johlin Frederick C, Rayhill Stephen C, Jensen Chris S, Jin Xie, Mitros Frank A
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Zhonghua Wai Ke Za Zhi. 2009 Aug 1;47(15):1155-61.
To report the experience in surveillance and early detection of cholangiocarcinoma (CC) and in using en bloc total hepatectomy-pancreaticoduodenectomy-orthotopic liver transplantation (OLT-Whipple) to achieve complete eradication of early-stage CC complicating primary sclerosing cholangitis (PSC).
Asymptomatic PSC patients underwent surveillance using endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) with multilevel brushings for cytological evaluation. Patients diagnosed with CC were treated with combined extra-beam radiotherapy, lesion-focused brachytherapy, and OLT-Whipple.
Between January 1988 and February 2001, 42 of 119 PSC patients were followed according to the surveillance protocol. CC was detected in 8 patients, 6 of whom underwent OLT-Whipple. Of those 6 patients, 4 had stage I CC, and 2 had stage II CC. All 6 OLT-Whipple patients received combined external-beam and brachytherapy radiotherapy. The median time from diagnosis to OLT-Whipple was 144 days. One patient died 55 months post-transplant of an unrelated cause, without tumor recurrence. The other 5 were well without recurrence at 79, 82, 108, 128, 129 and 145 months.
For patients with PSC, ERCP surveillance cytology and intralumenal endoscopic ultrasound examination allow for early detection of CC. Broad and lesion-focused radiotherapy combined with OLT-Whipple to remove the biliary epithelium en bloc offers promising long-term, tumor-free survival. All patients tolerated this extensive surgery well with good quality of life following surgery and recovery. These findings support consideration of the complete excision of an intact biliary tree via OLT-Whipple in patients with early-stage hilar CC complicating PSC.
报告胆管癌（CC）监测及早期发现的经验，以及采用整块全肝切除-胰十二指肠切除术-原位肝移植术（OLT-Whipple）实现对合并原发性硬化性胆管炎（PSC）的早期CC的彻底根除。
无症状PSC患者接受内镜超声及内镜逆行胰胆管造影（ERCP）监测，并进行多级刷检以进行细胞学评估。诊断为CC的患者接受外照射放疗、病灶聚焦近距离放疗及OLT-Whipple联合治疗。
1988年1月至2001年2月，119例PSC患者中有42例按照监测方案进行随访。8例患者检测出CC，其中6例接受了OLT-Whipple手术。这6例患者中，4例为I期CC，2例为II期CC。所有6例接受OLT-Whipple手术的患者均接受了外照射放疗和近距离放疗联合治疗。从诊断到OLT-Whipple手术的中位时间为144天。1例患者在移植后55个月因无关原因死亡，无肿瘤复发。其他5例患者在79、82、108、128、129和145个月时情况良好，无复发。
对于PSC患者，ERCP监测细胞学及腔内内镜超声检查可实现CC的早期发现。广泛及病灶聚焦放疗联合OLT-Whipple整块切除胆管上皮可带来有希望的长期无瘤生存。所有患者对这种广泛手术耐受性良好，术后生活质量及恢复情况良好。这些发现支持对合并PSC的早期肝门部CC患者考虑通过OLT-Whipple完整切除完整胆管树。
