COMBINED MINIMALLY INVASIVE TREATMENT OF CHOLANGIOCELLULAR CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE. INTRADUCTAL VIDEOFLUORESCENT DIAGNOSTICS – THE FIRST EXPERIENCE IN RUSSIA

Aim. To improve the diagnostic and treatment approaches for patients with unresectable liver cholangiocarcinoma. Material and Methods. Diagnosis and treatment of 14 patients are presented. Videofluorescent module was developed for diagnostics. For the first time in Russia we received videofluorescent image of bile ducts tumors and determined the accumulation of photosensitizers. In 12 patients the diagnosis was morphologically confirmed. Patients with unresectable cholangiocellular cancer underwent US- and X-ray-assisted percutaneous drainage of bile ducts. Videofluorescent diagnostics, photodynamic therapy of tumoral stricture and stent deployment were made after release of jaundice. Photodynamic therapy was performed using a fiber-optic system. Controlled balloon catheter on the distal segment was used if it was necessary to dilate the stricture and for uniform irradiation. Nitinol stent was deployed after photodynamic therapy. Photosens, Radachlorin and Photolon photosensitizers were used. Results. We acquired videofluorescence image of the tumor and determined the accumulation of photosensitizer in all patients. Cholangiocellular cancer was morphologically confirmed in 12 patients. The effectiveness of unresectable cholangiocellular cancer management was evaluated by survival. One patient was alive for 21 months, 3 patients – for 11, 13 and 17 months respectively. Five patients are under dynamic observation: two – for 12 and 18 months, three – from 3 to 6 months. Five patients died within 3 ± 1 months after treatment and initially had a lot of distant metastases. Conclusion. Videofluorescent diagnosis of cholangiocellular cancer determines the malignant nature of biliary lesion with high probability. Biliary stenting combined with photodynamic therapy allows us to establish a regular biliary passage and antineoplastic treatment that is associated with better results.

liver, bile ducts, cholangiocellular carcinoma, cholangiostomy, videofluorescent diagnostics, photodynamic therapy, stenting

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