Flowcharts for the management of biliary tract and ampullary carcinomas |
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| Authors: | Miyakawa Shuichi,Ishihara Shin,Takada Tadahiro,Miyazaki Masaru,Tsukada Kazuhiro,Nagino Masato,Kondo Satoshi,Furuse Junji,Saito Hiroya,Tsuyuguchi Toshio,Kimura Fumio,Yoshitomi Hideyuki,Nozawa Satoshi,Yoshida Masahiro,Wada Keita,Amano Hodaka,Miura Fumihiko Japanese Association of Biliary Surgery Japanese Society of Hepato-Biliary-Pancreatic Surgery Japan Society of Clinical Oncology |
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| Affiliation: | (1) Department of Gastroenterological Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan;(2) Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan;(3) Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan;(4) Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan;(5) Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;(6) Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan;(7) Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, Chiba, Japan;(8) Department of Radiology, Asahikawa Kosei General Hospital, Asahikawa, Japan;(9) Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan |
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| Abstract: | No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated type of PBM is a risk factor for gallbladder carcinoma. Symptoms that may indicate biliary tract carcinoma are jaundice and pain in the upper right area of the abdomen. The first step of diagnosis is to carry out blood biochemistry tests and ultrasonography (US) of the abdomen. The second step of diagnosis is to find the local extension of the carcinoma by means of computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP). Because resection is the only way to completely cure biliary tract carcinoma, the indications for resection are determined first. In patients with resectable disease, the indications for biliary drainage or portal vein embolization (PVE) are checked. In those with nonresectable disease, biliary stenting, chemotherapy, radiotherapy, and/or best supportive care is selected. |
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| Keywords: | Biliary tract carcinoma Bile duct carcinoma Gallbladder carcinoma Ampullary carcinoma Guidelines |
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