Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

Primary biliary tract tumors are malignancies that originate in the liver, bile ducts, or gallbladder. These tumors often present with jaundice of unknown etiology, leading to delayed diagnosis and advanced disease. Currently, several palliative treatment options are available for primary biliary tract tumors. They include percutaneous transhepatic biliary drainage (PTBD), biliary stenting, and surgical interventions such as biliary diversion. Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors. It involves the administration of chemotherapy drugs, such as gemcitabine and cisplatin, which have shown promising results in improving overall survival in patients with advanced biliary tract tumors. PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction. Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction. Surgical interventions, such as biliary diversion, have traditionally been used as palliative options for primary biliary tract tumors. However, biliary diversion only provides temporary relief and does not remove the tumor. Primary biliary tract tumors often present in advanced stages, making palliative treatment the primary option for improving the quality of life of patients.

A case of clear cell-hepatocellular carcinoma accidentally found in the gallbladder wall after laparoscopic resection of gallbladder empyema: Beware of the liver bed

INTRODUCTION AND IMPORTANCE

Hepatocellular carcinoma (HCC) invading the gallbladder is a rare scenario, even in the context of an advanced tumor. The clear cell variant of HCC (CC-HCC) is also rare. However, CC-HCC is more frequent in women and those with liver cirrhosis, and the standard definition is the presence of transparent cytoplasm in at least 50 % of tumor cells.

CASE PRESENTATION

An accidental finding of HCC was made during histological examination of a gallbladder empyema specimen from a 74 year-old male patient. The tumor was found to be invading the wall of the gallbladder. On post-operative imaging, the HCC was identified in liver segments 4b, 5 and 6, with extensive portal vein thrombosis; without other distant spread. The tumor in our case was almost exclusively comprised of clear cells (>90 %); therefore, it was classified as CC-HCC.

CLINICAL DISCUSSION

Tumors are rarely discovered along with acute cholecystitis. Furthermore, HCC rarely invades the wall of the gallbladder. HCC with clear cell histology should be distinguished from other regional and metastatic tumors of similar morphology.

CONCLUSION

In this particular case, we provide an unusual circumstance in which HCC invaded the gallbladder wall and was found by chance in a specimen obtained after a cholecystectomy. Malignancy remains an under-recognized clinical scenario that is easily overlooked when assessing patients presenting with cholecystitis. We report our case with an additional focus on the findings of computed tomography (CT) as well as the clinicopathological characteristics pertinent to this distinctive histologic pattern of CC-HCC.

Borderline Resectable and Locally Advanced Pancreatic Cancers: A Review of Definitions, Diagnostics, Strategies for Treatment, and Future Directions

ABSTRACT

Locally advanced and borderline resectable pancreatic cancers are being increasingly recognized as a result of significant improvements in imaging modalities. The main tools used in diagnosis of these tumors include endoscopic ultrasound, computed tomography, magnetic resonance imaging, and diagnostic laparoscopy. The definition of what constitutes a locally advanced or borderline resectable tumor is still controversial to this day. Borderline resectable tumors have been treated with neoadjuvant therapy approaches that aim at reducing tumor size, thus improving the chances of an R0 resection. Both chemotherapy and radiotherapy (solo or in combination) have been used in this setting. The main chemotherapy agents that have shown to increase resectability and survival are FOLFORINOX (a combination of folinic acid, fluorouracil, irinotecan, and oxaliplatin) and gemcitabine-nab-paclitaxel. Surgery on these tumors remains a significantly challenging task for pancreatic surgeons. More studies are needed to determine the best agents to be used in the neoadjuvant and adjuvant settings, biologic markers for prognostic and operative predictions, and validation of previously published retrospective results.

Robotic pancreas surgery: an overview of history and update on technique, outcomes, and financials

The use robotics in surgery is gaining momentum. This approach holds substantial promise in pancreas surgery. Robotic surgery for pancreatic lesions and malignancies has become well accepted and is expanding to more and more center annually. The number of centers using robotics in pancreatic surgery is rapidly increasing. The most studied robotic pancreas surgeries are pancreaticoduodenectomy and distal pancreatectomy. Most studies are in their early phases, but they report that robotic pancreas surgery is safe feasible. Robotic pancreas surgery offers several advantages over open and laparoscopic techniques. Data regarding costs of robotics versus conventional techniques is still lacking. Robotic pancreas surgery is still in its early stages. It holds promise to become the new surgical standard for pancreatic resections in the future, however, more research is still needed to establish its safety, cost effectiveness and efficacy in providing the best outcomes.