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J L Cameron

Publications and source records attributed to J L Cameron.

At least 91 records · Page 5Linked to original sources
PubMed1996

Biliary carcinoembryonic antigen levels are a marker for cholangiocarcinoma.

BACKGROUND: Cholangiocarcinoma develops in 5% to 15% of patients with choledochal cysts, sclerosing cholangitis, and intrahepatic stones. The detection of cholangiocarcinoma in patients with premalignant biliary conditions has been difficult. Serum levels of carcinoembryonic antigen (CEA) have been neither sensitive nor specific for the diagnosis of cholangiocarcinoma. However, CEA has been shown to be present in cholangiocarcinomas by immunohistochemical staining. Therefore, we measured the level of CEA excreted in bile in patients with benign strictures, premalignant biliary diseases, and cholangiocarcinoma. PATIENTS AND METHODS: Bile was obtained from transhepatic stents in patients with benign biliary strictures (34), choledochal cysts (5), primary sclerosing cholangitis (6), intrahepatic cholelithiasis (5), and perihilar cholangiocarcinoma (25). Samples were analyzed for CEA using a solid phase, two-site immunoenzymetric assay. RESULTS: Biliary CEA levels were significantly elevated (P < 0.01) in patients with cholangiocarcinoma (50.2 +/- 5.8 ng/mL) and intrahepatic cholelithiasis (57.4 +/- 10.4 ng/mL) compared with patients with benign strictures (10.1 +/- 3.9 ng/mL). Patients with sclerosing cholangitis (21.6 +/- 3.9 ng/mL) and choledochal cysts (20.0 +/- 16.5 ng/mL) had intermediate levels. In 5 patients undergoing resection of perihilar cholangiocarcinomas, the mean biliary CEA level decreased from a preoperative level of 46.8 +/- 6.7 ng/mL to a postoperative level of 11.3 +/- 5.6 ng/mL (P < 0.02). In 4 patients with progression of cholangiocarcinoma, biliary CEA increased from a mean of 53.3 +/- 6.9 ng/mL to 98.3 +/- 12.2 ng/mL (P < 0.02) over a mean interval of 9.5 months. CONCLUSIONS: Increased levels of CEA can be detected in the bile of patients with chlolangiocarcinoma. Monitoring these levels may have a role in the management of cholangiocarcinoma as well as premalignant biliary conditions such as choledochal cysts and sclerosing cholangitis.

Adult↗
PubMed1996

Pyogenic hepatic abscess. Changing trends over 42 years.

OBJECTIVE: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades. SUMMARY BACKGROUND DATA: Pyogenic hepatic abscess is a highly lethal problem. Over the past 2 decades, new roentgenographic methods, such as ultrasound, computed tomographic scanning, direct cholangiography, guided aspiration, and percutaneous drainage, have altered both the diagnosis and treatment of these patients. A more aggressive approach to the management of hepatobiliary and pancreatic neoplasms also has resulted in an increased incidence of this problem METHODS: The records of 233 patients with pyogenic liver abscesses managed over a 42-year period were reviewed. Patients treated from 1952 to 1972 (n = 80) were compared with those seen from 1973 to 1993 (n = 153). RESULTS: From 1973 to 1993, the incidence increased from 13 to 20 per 100,000 hospital admissions (p < 0.01. Patients managed from 1973 to 1993 were more likely (p < 0.01) to have an underlying malignancy (52% vs. 28%) with most of these (81%) being a hepatobiliary or pancreatic cancer. The 1973 to 1993 patients were more likely (p < 0.05) to be infected with streptococcal (53% vs. 30%) or Pseudomonas (30% vs. 9%) species or to have mixed bacterial and fungal 26% vs. 1%) infections. The recent patients also were more likely (p < 0.05) to be managed by percutaneous abscess drainage (45% vs. 0%). Despite having more underlying problems, overall mortality decreased significantly (p < 0.01) from 65% (in 1952 to 1972 period) to 31% (in 1973 to 1993 period). The reduction was greatest for patients with multiple abscesses (88% vs. 44%; p < 0.05) with either a malignant or a benign biliary etiology (90% vs. 38%; p < 0.05). Mortality was increased (p < 0.02) in patients with mixed bacterial and fungal abscesses (50%). From 1973 to 1993, mortality was lower (p = 0.19) with open surgical as opposed to percutaneous abscess drainage (14% vs. 26%). CONCLUSIONS: Significant changes have occurred in the etiology, diagnosis, bacteriology, treatment, and outcome patients with pyogenic hepatic abscesses over the past 4 decades. However, mortality remains high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fungal agents as well as adequate surgical, percutaneous, or biliary drainage are required for the best results.

Age Distribution↗
PubMed1996

Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer?

OBJECTIVE: The authors define the role of palliative pancreaticoduodenectomy in patients with pancreatic carcinoma. BACKGROUND: Decreases in perioperative morbidity and mortality and improved long-term survival associated with pancreaticoduodenectomy for patients with pancreatic carcinoma have clearly established a role for this operation when performed with curative intent. However, most surgeons remain hesitant to perform pancreaticoduodenectomy unless surgical margins are widely clear, choosing rather to perform palliative biliary and gastric bypass. METHODS: A single-institution retrospective review was performed comparing the outcome of 64 consecutive patients undergoing pancreaticoduodenectomy for pancreatic carcinoma with gross or microscopic evidence of adenocarcinoma at the surgical resection margins, and 62 consecutive patients found to be unresectable at the time of laparotomy because of local invasion without evidence of metastatic disease (stage III). Combined biliary and gastric bypass were performed in 87% of patients not resected. RESULTS: The two groups were similar with respect to age, gender, race, and presenting symptoms. The hospital mortality rate was identical in both groups (1.6%). Fifty-eight percent of patients undergoing pancreaticoduodenectomy had an uncomplicated postoperative course compared with 68% of patients undergoing palliative bypass (not significant). The length of postoperative hospital stay after pancreaticoduodenectomy was 18.4 days, which was significantly longer (p < 0.05) than for patients undergoing palliative bypass (15.0 days). The overall actuarial survival (Kaplan-Meier) was improved significantly in patients undergoing pancreaticoduodenectomy (p < 0.02). Postoperative chemotherapy and radiation therapy improved survival in both groups. CONCLUSIONS: Pancreaticoduodenectomy can be performed with a similar perioperative morbidity and mortality and only a minimal increase in hospital stay when compared with traditional surgical palliation. Pancreaticoduodenectomy with postoperative chemotherapy and radiation therapy is associated with improved long-term survival when compared with patients treated with surgical bypass. These data support the role of palliative pancreaticoduodenectomy in patients with pancreatic carcinoma and with local residual disease.

Adenocarcinoma↗
PubMed1996

Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors.

OBJECTIVE: The objective of this article is to introduce a simple method for classifying cholangiocarcinomas and to apply this system to analyze a large number of patients from a single institution. SUMMARY BACKGROUND DATA: For the past 2 decades, most western reports on cholangiocarcinoma have separated intrahepatic from extrahepatic tumors and have subclassified this latter group into proximal, middle, and distal subgroups. However, "middle" lesions are uncommon and are managed most often either with hilar resection or with pancreatoduodenectomy. The spectrum of cholangiocarcinoma, therefore, is best classified into three broad groups: 1) intrahepatic, 2) perihilar, and 3) distal tumors. These categories correlate with anatomic distribution and imply preferred treatment. METHODS: The records of all patients with histologically confirmed cholangiocarcinoma who underwent surgical exploration at The Johns Hopkins Hospital over a 23-year period were reviewed. RESULTS: Of 294 patients with cholangiocarcinoma, 18 (6%) had intrahepatic, 196 (67%) had perihilar, and 80 (27%) had distal tumors. Age, gender, race, and associated diseases were similar among the three groups. Patients with intrahepatic tumors, by definition, were less likely (p < 0.01) to be jaundiced and more likely (p < 0.05) to present with abdominal pain. The resectability rate increased with a more distal location (50% vs. 56% vs. 91%), and resection improved survival at each site. Five-year survival rates for resected intrahepatic, perihilar, and distal tumors were 44%, 11%, and 28%, and median survival rates were 26, 19, and 22 months, respectively. Postoperative radiation therapy did not improve survival. In a multivariate analysis resection (p < 0.001. hazard ratio 2.80), negative microscopic margins (p < 0.01, hazard ratio 1.79), preoperative serum albumin (p < 0.04, hazard ratio 0.82), and postoperative sepsis (p < 0.001, hard ratio 0.27) were the best predictors of outcome. CONCLUSIONS: Cholangiocarcinoma is best classified into three broad categories. Resection remains the primary treatment, whereas postoperative adjuvant radiation has no influence on survival. Therefore, new agents or strategies to deliver adjuvant therapy are needed to improve survival.

Bile Duct Neoplasms↗
PubMed1996

Stimulation of luteinizing hormone secretion by food intake: evidence against a role for insulin.

In adult male rhesus monkeys, 1 day of fasting leads to a profound suppression of LH secretion that is rapidly reversed with refeeding. To test the hypothesis that changes in insulin secretion during fasting and refeeding mediate the changes in LH secretion, blood samples for LH measurement were obtained between 0900-2400 h from adult male rhesus monkeys (n = 9) on 1) a day when monkeys were refed their normal meal after a day of fasting, and 2) a day when monkeys were refed their normal meal, but endogenous insulin secretion was suppressed. Diazoxide (7.5-9.5 mg/kg.h) caused a 40-99% suppression of postmeal insulin secretion. However, no significant differences in LH pulse frequency, pulse amplitude, or mean serum LH levels were detected between control and diazoxide trials, even in animals in which insulin was markedly suppressed. Further, no correlation existed between the degree of insulin suppression and the magnitude of the meal-induced stimulation of LH. We conclude that meal-induced insulin secretion does not provide the stimulus mediating the meal-induced increase in LH secretion.

Animals↗
PubMed1996

Feeding-induced stimulation of luteinizing hormone secretion in male rhesus monkeys is not dependent on a rise in blood glucose concentration.

Recent studies have suggested a role for glucose availability in the central control of reproductive function. Various experimental paradigms have shown that a large pharmacological reduction in circulating or cellular glucose levels can suppress LH secretion, ovulation, and reproductive behavior. In contrast, states of undernutrition, which are also associated with a suppression of reproductive function, are accompanied by very mild changes in circulating glucose levels. In monkeys, 1 day of fasting leads to a significant suppression of LH secretion before any significant change in blood glucose levels, and by 2 days of fasting, circulating glucose levels only decrease by about 20%. Refeeding a normal meal after 2 days of fasting results in a restoration of euglycemia and a rapid stimulation of LH secretion. To test the hypothesis that physiological changes in glucose levels occurring during brief periods of fasting and refeeding can modulate LH secretion, we provided monkeys that had been fasted for 2 days with meals that differed in the ability to raise blood glucose levels. Meals consisting of mixed nutrients, carbohydrate only, or protein and fat were provided to monkeys through indwelling gastric cannulas. Mixed nutrient infusions and carbohydrate infusions caused a rise in blood glucose as well as a robust stimulation of LH secretion. However, protein and fat meals also stimulated LH secretion, even though no rise in blood glucose concentrations occurred. Thus, the restoration of pulsatile LH secretion when fasted animals are refed is not dependent on an elevation in circulating glucose levels. These results do not support the hypothesis that physiological changes in circulating glucose levels play a necessary role in mediating the changes in LH secretion that occur with fasting and refeeding. Alternatively, these results support the hypothesis that the availability of metabolizable fuels, regardless of their nature, provides a critical cue that regulates the central drive to the reproductive axis under physiological conditions of fasting and feeding.

Animal Feed↗
PubMed1996

Short-term neuroendocrine effects of a large oral dose of monosodium glutamate in fasting male subjects.

Fasting male subjects received each of four treatments on different days: a large oral dose of monosodium L-glutamate (MSG; 12.7 g), the MSG vehicle, an iv injection of TRH, or a high protein meal. Blood samples were drawn via an indwelling venous line before and at 20-min intervals after each treatment for 4 h. Plasma glutamate levels rose 11-fold within 1 h of MSG ingestion, but did not change appreciably with any of the other treatments. Plasma PRL levels rose 10-fold after TRH infusion and 2-fold after the protein meal, but did not rise significantly after MSG ingestion. No effects resulted from any of the treatments on plasma LH, FSH, testosterone, GH, or cortisol concentrations. Plasma levels of TSH, T4, and T3 showed minimal changes after any of the treatments except TRH; TRH elevated plasma TSH and T3 levels. Self-rating instruments of mood and side-effects revealed no treatment-related effects on mood or physical state for up to 48 h after each treatment. Together, these results suggest that acute pharmacological elevations of plasma glutamate levels in adult men produce minimal, if any, effects on hypothalamic or pituitary function.

Administration, Oral↗
PubMed1996

Regulation of reproductive hormone secretion in primates by short-term changes in nutrition.

In primates, as in nonprimates, it is well established that periods of chronic or severe undernutrition can lead to a suppression of reproductive hormone secretion. Recent studies in monkeys and humans indicate that reproductive hormone secretion begins to be suppressed with even very brief periods of undernutrition. Specifically, in male monkeys reproductive hormone secretion responds to missing a single meal, eating a single meal, and to a change in the timing of daily meal intake. These findings suggest that nutritional/metabolic signals that are linked to food intake are part of the normal physiological mechanism regulating the daily activity of the reproductive axis, rather than simply signals that influence the activity of the reproductive axis in pathological conditions of severe undernutrition. The nature of the metabolic cue(s) linking reproductive hormone secretion to subtle changes in the metabolic status of the body remains unknown, as does the route by which metabolic information reaches the central hypothalamic neurones governing reproductive hormone secretion. However, recent studies indicate that the metabolic cue transmitting information to the reproductive axis is dependent on calorie intake, but is not dependent on changes in body mass or composition, changes in intake of a specific nutrient, changes in plasma glucose or insulin concentrations, or signals emanating from the taste or smell of food or the physical process of food ingestion.

Animal Nutritional Physiological Phenomena↗
PubMed1996

Pancreatic nodal metastases: biologic significance and therapeutic considerations.

Adenocarcinoma of the pancreas remains a disease in which the majority of patients succumb to the neoplastic process, even after potentially curative resection. There has been an overall improvement in patient outcome in recent years, partially explicable by the increasing safety of pancreaticoduodenal resection. Factors that have been identified as being important in long-term survival include diploid tumor DNA content, small tumor size, absence of lymph node metastases, and resection with negative resection margins. Another factor that appears to favor long-term survival is the use of postoperative combined modality chemoradiation therapy. Clearly, newer treatment modalities should be evaluated in the hope of improving outcome. Additionally, developments in earlier detection and staging, via applications from the field of molecular genetics, may provide further improvements in outcome.

Humans↗
PubMed1996

Current management of patients with perihilar cholangiocarcinoma.

Despite the overall advances in the ability to diagnose and treat patients with perihilar cholangiocarcinoma, the prognosis for patients with this malignancy remains poor. Further improvements in the survival of patients with perihilar cholangiocarcinoma will come with the early diagnosis of these lesions. New molecular techniques should improve our ability to screen high-risk patients, such as those with primary sclerosing cholangitis, hepatolithiasis, choledochal cysts, and ulcerative colitis. Improvements in diagnostic CT scanning, duplex ultrasonography, and MRI will enhance our ability to noninvasively stage patients with perihilar cholangiocarcinoma. Complete surgical resection remains the only curative treatment for malignancies of the biliary tract. Aggressive surgical approaches are likely to continue, and the challenge remains being able to perform these procedures safely in jaundiced and sometimes septic patients. For those patients with unresectable lesions, the optimal form of palliation, whether operative or nonoperative, remains to be defined. Finally, advances in adjuvant chemotherapy and radiotherapy will be required to further improve the overall prognosis of patients with perihilar cholangiocarcinoma.

Bile Duct Neoplasms↗
PubMed1995

Detailed characterization of experimental acute alcoholic pancreatitis.

BACKGROUND: With the ex vivo perfused canine pancreas preparation, the infusion of acetaldehyde, the primary metabolite of ethanol oxidation, plus a short period of ischemia to convert xanthine dehydrogenase to xanthine oxidase, results in the physiologic injury response of acute pancreatitis (edema, weight gain, hyperamylasemia). The free radical scavengers superoxide dismutase and catalase and a xanthine oxidase inhibitor, allopurinol, ameliorate this injury response, suggesting that toxic oxygen metabolites generated by xanthine oxidase play an intermediary role. METHODS: The isolated ex vivo canine pancreas preparation was perfused for 4 hours, and weight gain of the preparation and amylase activity in the perfusate were monitored. Changes in pancreatic acinar cell architecture were characterized by light and electron microscopy, and intracellular phosphate metabolism was followed by magnetic resonance spectroscopy in control preparations and in glands simulating alcoholic pancreatitis. RESULTS: Control preparations and preparations with a 1-hour period of ischemia before perfusion gained little weight (7 +/- 3 gm and 8 +/- 1 gm), amylase activity in the perfusate remained normal (933 +/- 513 units/dl and 1537 +/- 553 units/dl), and no changes in architecture were observed. Weight gain (5 +/- 6 gm) and amylase activity (1188 +/- 173 units/dl) were also normal in the preparations receiving acetaldehyde without preceding ischemia, but mild vascular and islet cell injury were observed on electron microscopy. One hour of ischemia followed by acetaldehyde infusion resulted in edema, increased weight gain (21 +/- 12 gm [p < 0.05]), and amylase activity (2487 +/- 1484 units/dl [p < 0.05]). Microscopy showed mild acinar cell damage and greater injury to the capillaries and the islets. The capillary and islet cell changes were reduced by superoxide dismutase and catalase. Intracellular adenosine triphosphate levels remained at baseline levels in the control preparations. Adenosine triphosphate decreased during ischemia but quickly recovered during perfusion without a significant difference whether acetaldehyde was infused after ischemia. An iron chelator desferoxamine ameliorated the injury response in the preparations simulating acute pancreatitis (weight gain, 13 +/- 6 gm [p = 0.09] and amylase activity, 1198 +/- 471 units/dl [p = 0.08]), but a cholecystokinin receptor antagonist L364,718 did not have an effect. A sulfhydryl group protector, dithiothreitol, decreased weight gain (10 +/- 7 gm [p = 0.06]), and amylase activity was not significantly increased over that of the control group (1582 +/- 641 units/dl), but a serine protease inhibitor phenylmethylsulphonylfluoride was ineffective. CONCLUSIONS: In this model simulating acute alcoholic pancreatitis, both the early physiologic injury response and the early morphologic changes are mediated at least in part by free radicals, which are generated by xanthine oxidase converted reversibly from xanthine dehydrogenase. In addition to the superoxide radical, the hydroxyl radical may also be an important early intermediate step, but the cholecystokinin receptor is not.

Acetaldehyde↗
PubMed1995

Long-term survival following pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas.

Survival following pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas has clearly improved over the past several decades. Evidence from the Johns Hopkins Hospital series indicates that it has continued to improve from the 1970s to the 1980s to the 1990s. The reasons for this improvement are multiple. Between the 1970s and 1980s a decrease in operative and hospital mortality clearly played an important role. In addition, the markedly decreased number of blood transfusions given during pancreaticoduodenectomy in the 1980s probably contributed to the improvement in long-term survival. Positive resection margins were more common in the 1970s than in the 1980s and 1990s, and that probably played a major role. It is unlikely, however, that any of these factors played a role in the improvement in survival between the 1980s and 1990s. Perhaps the increasing use of adjuvant therapy is primarily responsible for the most recent improvement. Whatever the reasons, more patients are surviving pancreaticoduodenectomy, and among those patients who survive the operation, more people are surviving for prolonged periods. It is clear that we now have an effective operation for patients with adenocarcinoma of the head of the pancreas who are detected early, prior to lymph node spread. If we can find a tumor marker that allows us to identify more patients prior to nodal spread, substantial improvement in survival will accrue. In addition, better adjuvant therapy is needed, as the adjuvant regimens used today, which clearly prolong survival, almost certainly can be improved upon.

Adenocarcinoma↗
PubMed1995

The effects of regionalization on cost and outcome for one general high-risk surgical procedure.

PURPOSE: The effects of regionalization of tertiary care were studied by analyzing cost and outcome for pancreaticoduodenectomies in a state in which the majority of these high-risk procedures were performed in one hospital. METHODS: Using Maryland inpatient discharge data via a retrospective study, the authors compared cost and outcome data for a hospital with more than one half of the cases in the state to all other hospital providers as a group and with smaller groupings according to the volume of procedures performed. RESULTS: Hospital mortality, length of stay, and costs were significantly less at the high-volume regional medical center when compared with all other hospitals. Mortality and cost increased as volume decreased when hospitals were grouped according to volume. CONCLUSIONS: An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.

Academic Medical Centers↗
PubMed1995

Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients.

OBJECTIVE: This single-institution study examined the outcome after pancreaticoduodenectomy in patients with adenocarcinoma of the head of the pancreas. SUMMARY OF BACKGROUND DATA: In recent years, pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas has been associated with decreased morbidity and mortality and, in some centers, 5-year survival rates in excess of 20%. METHODS: Two hundred one patients with pathologically verified adenocarcinoma of the head of the pancreas undergoing pancreaticoduodenectomy at The Johns Hopkins Hospital between 1970 and 1994 were analyzed (the last 100 resections were performed between March 1991 and April 1994). This is the largest single-institution experience reported to date. RESULTS: The overall postoperative in-hospital mortality rate was 5%, but has been 0.7% for the last 149 patients. The actuarial 5-year survival for all 201 patients was 21%, with a median survival of 15.5 months. There were 11 5-year survivors. Patients resected with negative margins (curative resections: n = 143) had an actuarial 5-year survival rate of 26%, with a median survival of 18 months, whereas those with positive margins (palliative resections; n = 58) fared significantly worse, with an actuarial 5-year survival rate of 8% and a median survival of 10 months (p < 0.0001). Survival has improved significantly from decade to decade (p < 0.002), with the 3-year actuarial survival of 14% in the 1970s, 21% in the 1980s, and 36% in the 1990s. Factors significantly favoring long-term survival by univariate analyses included tumor diameter < 3 cm, negative nodal status, diploid tumor DNA content, tumor S phase fraction < 18%, pylorus-preserving resection, < 800 mL intraoperative blood loss, < 2 units of blood transfused, negative resection margins, and use of postoperative adjuvant chemotherapy and radiation therapy. Multivariate analyses indicated the strongest predictors of long-term survival were diploid tumor DNA content, tumor diameter < 3 cm, negative nodal status, negative resection margins, and decade of resection. CONCLUSIONS: The survival of patients with pancreatic adenocarcinoma treated by pancreaticoduodenectomy is improving. Aspects of tumor biology, such as DNA content, tumor diameter, nodal status and margin status, are the strongest predictors of outcome.

Actuarial Analysis↗
PubMed1995

Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival.

OBJECTIVE: The aims of this analysis were to determine prospectively the effects of surgical resection and radiation therapy on the length and quality of survival as well as late toxicity in patients with perihilar cholangiocarcinoma. BACKGROUND: Retrospective analyses have suggested that adjuvant radiation therapy improves survival in patients with perihilar cholangiocarcinoma. However, in these reports, patients receiving radiotherapy tended to have smaller, often resectable tumors, and were relatively fit. In comparison, patients who have not received radiotherapy often had unresectable tumors, metastatic disease, or poor performance status. METHODS: From 1988 through 1993, surgically staged patients with perihilar cholangiocarcinoma and 1) no evidence of metastatic disease, 2) Karnofsky score > 60, 3) no prior malignancy or radiotherapy, and 4) a patent main portal vein were analyzed. Fifty patients were stratified by resection (n = 31) versus operative palliation (n = 19) and by radiation (n = 23) versus no radiotherapy (n = 27). RESULTS: Patients undergoing resection had smaller tumors (1.9 +/- 2.8 vs. 2.4 +/- 2.1 cm, p < 0.01) that were less likely to invade the hepatic artery (3% vs. 42%, p < 0.05) or portal vein (6% vs. 53%, p < 0.05). Multiple parameters that might have affected outcome were similar between patients who did and did not receive radiation therapy. Resection improved the length (24.2 +/- 2.5 vs. 11.3 +/- 1.0 months, p < 0.05) and quality of survival. Radiation had no effect on the length (18.4 +/- 2.9 vs. 20.1 +/- 2.4 months) or quality of survival or on late toxicity. CONCLUSIONS: This analysis suggests that in patients with localized perihilar cholangiocarcinoma, resection prolongs survival whereas radiation has no effect on either survival or late toxicity. Thus, new agents or strategies to deliver adjuvant therapy are needed to improve survival in these patients.

Bile Duct Neoplasms↗