Prevention of implantation metastases after resection of proximal bile duct tumours with pre-operative low dose radiation therapy

• Published in: European journal of surgical oncology 2000-08, Vol.26 (5), p.480-485
• Main Authors: Gerhards, MF, Gonzalez Gonzalez, D, ten Hoopen-Neumann, H, van Gulik, TM, de Wit, T Th, Gouma, DJ
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bile Duct Neoplasms - prevention & control; Bile Duct Neoplasms - radiotherapy; Bile Duct Neoplasms - surgery; Bile Ducts, Extrahepatic; Biliary Tract Surgical Procedures - adverse effects; Biological and medical sciences; Dose Fractionation; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; implantation metastases; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local - prevention & control; Neoplasm Seeding; proximal bile duct; radiation therapy; Radiotherapy, Adjuvant; resection; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Tumors
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1053/ejso.1999.0926

Aims: Pre-operative endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage is associated with a greater risk of implantation metastases after resection of proximal bile duct tumours. In a previous study among patients who had undergone biliary drainage before resection, eight patients (20%) developed implantation metastases, within 1 year following resection. The aim of this analysis was to evaluate the results of pre-operative irradiation with regard to a possible reduction of implantation metastases. Methods: Twenty-one patients with proximal bile duct tumours who had undergone resection following pre-operative irradiation were retrospectively analysed. Pre-operative radiation therapy consisted of three fractions of 3.5 Gy external beam irradiation of the hilar area. Results: Pre-operative biliary drainage was performed in 19 patients (90%). All patients received pre-operative radiotherapy during which no complications were noted. None of the patients developed implantation metastases within a follow-up time of 2 to 79 months. Conclusion: The results of this study suggest that pre-operative radiotherapy in patients with a resectable proximal bile duct tumour who have undergone pre-operative drainage, decreases the risk of implantation metastases. To be certain about the role of pre-operative radiotherapy, a randomized study is required. Until then, we advocate standard low dose radiotherapy preceding resection in all patients with lesions suggestive of a proximal bile duct tumour who have undergone biliary drainage.