Survival and an overview of decision-making in patients with cholangiocarcinoma

BACKGROUND:Cholangiocarcinoma is rare,accounting for approximately 3%of all gastrointestinal cancers.This study aimed to identify the survival rate among surgically treated and palliated patients,and secondly to identify parameters that could predict a curative resection. METHODS:A total of 121 patients,55 men and 66 women, median age 70 years(range 31-91),who had been treated for cholangiocarcinoma in the period of 1990-2005 were evaluated retrospectively. RESULTS:Curative resection was performed in 40 patients (33%),whereas 81 received palliative treatment(67%).16% (19 of 121)of the patients had an explorative laparotomy without tumour resection.Age above 65 years(OR 3.4;95% CI 1.4-8.4;P=0.008),weight loss(OR 8.5;95%CI 1.5-46; P=0.01)or tumour location(The resection rate of hilar cholangiocarcinoma was lower than that of intrapancreatic cancer.)(OR 2.7;95%CI 1.7-4.5;P=0.001)predicted palliative treatment.The adjusted 5-year survival rate of patients who received tumour resection and palliative treatment was 30%and 1.2%,respectively(P<0.001).The survival rate of patients who were subjected to hepatectomy (70%)was better than that of patients who had a local or distal resection(20%)(P=0.02). CONCLUSIONS:In few patients with a resectable cholangiocarcinoma,an explorative laparotomy is often necessary to evaluate resectability.However,long-term survival is significantly better in patients who received radical surgical resection.

Cystic Tumours of the Pancreas – a Rare and Diverse Type of Tumours

Objective: Increasing incidence of non-inflammatory cystic lesions of the pancreas challenges work-up algorithms, surgery and surveillance. We have reviewed our experience with these tumours in accordance with International Consensus Guidelines and evaluated the outcome. Patients and Methods: From 1999 to 2009, 34 cases referred to Haukeland University Hospital were operated upon;ten were serous (SCN), twenty-one IPMNs, one MCN, and two solid pseudopapillary neoplasms (SPPN). A thorough medical history was supplemented by CT, MRI, and US before each case were discussed in a MDT to decide on the best subsequent care. Results: All SCN and SPPN patients had benign histopathology, and no deaths were reported. Survival for malignant IPMN was, 2 years: 75%, and 5 years: 67%, where after no deaths were registered in the observation period. Presence of jaundice had the highest impact on survival (p = 0.0009), followed by weight loss (p = 0.005) and dilatation of the common bile duct (p = 0.04). In the IPMN group two had pancreatic juice leakage, and reoperation was performed in one. Conclusions: All SCN turned out benign which justify a high threshold for resection unless unacceptable symptoms dominate. For branch duct IPMNs resections of asymptomatic and smaller lesions (<3 cm) should be avoided but kept under surveillance, whereas symptomatic and lager lesions together with main duct IPMNs lodge a substantial malignant potential and should be resected. Symptomatic or large SPPNs can be, or turn, malignant which require resection.

Bioactive Fatty Acids Reduce Development of Gastric Cancer Following Duodenogastric Reflux in Rats

Background: Bioactive fatty acids such as the eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the modified fatty acid analogue, tetradecylthioacetic acid (TTA), are known to influence inflammatory processes in the body. Our aim was to investigate if diets containing fish oil (FO) enriched with bioactive fatty acids could affect inflammation and development of glandular stomach carcinogenesis in a duodenogastric reflux (DGR) animal model. We also wanted to evaluate if a high-fat diet might increase the risk of developing gastric cancer compared to a low-fat diet. Methods: 185 rats operated on with a gastroenterostomy were randomly allocated to 5 different treatment groups given: low-fat, high-fat, high-fat + FO, high-fat + TTA or high-fat + FO + TTA. The stomachs were removed after 50 weeks and examined by light microscopy with hematoxylin and eosin staining (HE). Immunohistochemical staining against COX-2, PCNA and p53 was performed when adenocarcinomas were found. The plasma fatty acid profile was determined. Results: Adenocarcinomas developed in 21% of animals fed the low-fat diet, 35% in the high-fat group, 16% in the high-fat + TTA group, 21% in the high-fat + FO group and 8.6% in the high-fat + FO + TTA treatment group. COX-2 and PCNA were positive whereas p53 was negative in the majority of the samples. The anti-inflammatory fatty acid index increased after treatment with FO and in combination with FO and TTA. Conclusion: FO and TTA in combination with a high-fat diet significantly lower the risk of developing adenocarcinomas in rats subjected to duodenogastric reflux. This is most likely due to a selective modulation of inflammation.