Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making.

Autor:	de Jong DM; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands., van de Vondervoort S; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands., Dwarkasing RS; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands., Doukas M; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Pathology, Rotterdam, Netherlands., Voermans RP; Amsterdam University Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands., Verdonk RC; St. Antonius Hospital, Department of Gastroenterology and Hepatology, Nieuwegein, Netherlands., Polak WG; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands., de Jonge J; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands., Koerkamp BG; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands., Bruno MJ; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands., van Driel LMJW; Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands.
Jazyk:	angličtina
Zdroj:	Endoscopy international open [Endosc Int Open] 2023 Feb 02; Vol. 11 (2), pp. E162-E168. Date of Electronic Publication: 2023 Feb 02 (Print Publication: 2023).
DOI:	10.1055/a-2005-3679
Abstrakt:	Background and study aims  Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with extraregional metastatic LNs (MLNs). This study investigates the added value of preoperative endoscopic ultrasound (EUS) with or without tissue acquisition (TA) for the detection of MLNs in patients with resectable pCCA. Patients and methods  In this retrospective, multicenter cohort study, patients with potentially resectable pCCA who underwent EUS preoperatively between 2010-2020, were included. The clinical impact of EUS-TA was defined as the percentage of patients who did not undergo surgical resection due to MLNs found with EUS-TA. Findings of cross-sectional imaging were compared with EUS-TA findings and surgery. Results  EUS was performed on 141 patients, of whom 107 (76 %) had suspicious LNs on cross-sectional imaging. Surgical exploration was prevented in 20 patients (14 %) because EUS-TA detected MLNs, of which 17 (85 %) were extraregional. Finally, 74 patients (52 %) underwent surgical exploration followed by complete resection in 40 (28 %). MLNs were identified at definitive pathology in 24 (33 %) patients, of which 9 (38 %) were extraregional and 15 (63 %) regional. Conclusions  EUS-TA may be of value in patients with potentially resectable pCCA based on preoperative cross-sectional imaging, regardless of lymphadenopathy at cross-sectional imaging. A prospective study in which a comprehensive EUS investigation with LN assessment and EUS-TA of LNs is performed routinely should confirm this promise. Competing Interests: Competing interests Dr. Bruno received research funding for industry-initiated studies from Boston Scientific and Cook Medical. He received research funding for investigator initiated studies from Boston Scientific, Cook Medical, Pentax Medical, Interscope, Mylan and ChiRoStim. He is a consultant to Boston Scientific, Cook Medical, and Pentax Medical. Dr. Voermans received research funding for investigator initiated studies from Boston Scientific and Prion Medical. He is a consultant with speakers fee for Boston Scientific. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze:	MEDLINE
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