Cholangitis as a late complication in long-term survivors after surgery for biliary atresia

Abstract Background Although cancer occurrence following surgery for biliary atresia has gradually increased, the development of cholangiocarcinoma in a native liver survivor of biliary atresia is extremely rare. Case presentation A 3-month-old female patient with the correctable type of biliary atresia underwent a cystoduodenostomy. At 16 years of age, she underwent multiple surgeries including lysis of intestinal adhesions, ileostomy, and gastrojejunostomy at another hospital. At 54 years of age, she underwent lithotomy at the porta hepatis, resection of the residual cystic bile duct with gallbladder, and hepaticojejunostomy in Roux-en-Y fashion. As she approached the age of 63, her computed tomography scan showed no liver tumors. In the following year, she developed cholangiocarcinoma at the porta hepatis and underwent chemotherapy. However, the cancer progressed, and she died before she reached the age of 64 years. Conclusions Cholangiocarcinoma is extremely rare in patients with biliary atresia. However, physicians should follow up patients with biliary atresia as closely as possible, as malignant tumors secondary to biliary atresia may increase in number in the near future because of the growing number of long-term survivors with biliary atresia.

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Clinicopathological study of a hilar nodule in the livers of long‐term survivors with biliary atresia

Pathology International ◽

10.1046/j.1440-1827.2001.01161.x ◽

2001 ◽

Vol 51 (1) ◽

pp. 16-19 ◽

Cited By ~ 8

Author(s):

Rieko Ijiri ◽

Yukichi Tanaka ◽

Keisuke Kato ◽

Kazuaki Misugi ◽

Yokatsu Ohama ◽

...

Keyword(s):

Biliary Atresia ◽

Clinicopathological Study ◽

Long Term Survivors

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Hypertension in long-term survivors of childhood renal cancers.

Journal of Clinical Oncology ◽

10.1200/jco.1989.7.7.912 ◽

1989 ◽

Vol 7 (7) ◽

pp. 912-915 ◽

Cited By ~ 28

Author(s):

A F Kantor ◽

F P Li ◽

A J Janov ◽

N J Tarbell ◽

S E Sallan

Keyword(s):

Wilms Tumor ◽

Late Complication ◽

Renal Surgery ◽

Borderline Hypertension ◽

Case Comparison ◽

History Of ◽

Family History Of Hypertension ◽

Male Patients ◽

Long Term Survivors

The prevalence of hypertension was investigated in 119 adults who have survived for up to 53 years following the diagnosis of renal cancer in childhood (Wilms' tumor, 116 patients; renal carcinoma, three patients). Twenty-four (20%) have developed definite or borderline hypertension, as compared with 18.1 cases expected based on US population rates (relative risk [RR], 1.3; 95% confidence interval [CI], 0.9 to 2.0; P = .20). This nonsignificant excess is due to the heightened prevalence of definite hypertension among one subgroup of male patients. The findings are not explained by cigarette smoking, obesity, age, and stage at diagnosis of Wilms' tumor, or family history of hypertension. A case-comparison analysis within the cohort showed no consistent hypertensive effect associated with radiation therapy dose, radiotherapy concurrent with dactinomycin chemotherapy, or extent of renal surgery. Hypertension is not a common late complication of Wilms' tumor in our patients.

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Studies on the postoperative changes in the liver tissue of long-term survivors after successful surgery for biliary atresia

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(81)80073-5 ◽

1981 ◽

Vol 16 (4) ◽

pp. 532

Author(s):

Thomas A. Angerpointner

Keyword(s):

Biliary Atresia ◽

Liver Tissue ◽

Postoperative Changes ◽

Long Term Survivors

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High Incidence of Radiation Induced Cavernous Hemangioma (RICH) in Long Term Survivors Who Underwent BMT with Radiation Therapy During Childhood or Adolescence.

Blood ◽

10.1182/blood.v114.22.4292.4292 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4292-4292

Author(s):

Takashi Koike ◽

Noriharu Yanagimachi ◽

Hiromasa Yabe ◽

Miharu Yabe ◽

Tsuyoshi Morimoto ◽

...

Keyword(s):

Radiation Therapy ◽

Cavernous Hemangioma ◽

Late Complication ◽

Weighted Image ◽

Primary Disease ◽

High Incidence ◽

Radiation Induced ◽

Long Term Survivors ◽

The Brain

Abstract Abstract 4292 INTRODUCTION Radiation induced cavernous hemangioma (RICH) is a late complication of cerebral radiation therapy. An increased number of long term surviving blood and marrow transplantation (BMT) recipients have recovered from their primary disease but are at risk of RICH. METHODS We investigated 66 patients who underwent BMT during childhood or adolescence. We evaluated RICH numbers, size, location and their annual changes. Furthermore we developed scoring system of RICH in order to classify severity. MRI of the brain was performed annually for 5 to 27 years after BMT, including gradient-echo sequence (T2* weighted image). RICH SCORE 1-4 is designated as mild, 5-9 as moderate and 10 or more as severe. RESULTS Twenty-five patients (37.9%) was diagnosed RICH. The age at the time of the diagnosis was 11-40 years old (median 27 years old). The age at the time of BMT was 1-22 years old (median 9 years old). The period from BMT to diagnosis was 10-24 years (median 16 years). All cases received TBI as conditioning of BMT and/or cranial radiation (CR) prior to BMT as treatment of primary disease. RICH was found in 25/48 (52%) who received TBI and/or CR, and was not found in any of 18 patients without radiation therapy to the brain. Total dose to the brain was 10-36 Gy. Clinical manifestations were present only in four cases. RICH SCORE ranged 1-18 points (median 4 points). Small RICHs tended to be recognized only by T2* weighted image, but not by routine imaging methods. Classification of the severity was mild in 13 patients, moderate in 8 patients and severe in 4 patients. Severity was correlated with higher radiation dose and/or with younger ages at transplantation. RICH SCORE increased yearly in 7 of 25 patients. One case developed giant RICH more than 40mm as shown in the attached image. CONCLUSION High incidence of RICH was found in long term survivors who underwent BMT with radiation therapy. Since all of those patients did not show RICH before BMT and all positive patients had a history of radiation therapy to the brain, the cause of RICH in those patients was considered to be radiation. Careful and long term evaluation with MRI including T2* weighted image is necessary in BMT recipients who received radiation therapy prior and/or during BMT. Disclosures: Ando: Alexion: Research Funding.

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Late complications in long-term survivors of biliary atresia

Journal of Pediatric Surgery ◽

10.1016/0022-3468(92)90244-2 ◽

1992 ◽

Vol 27 (11) ◽

pp. 1480

Author(s):

Thomas A. Angerpointner

Keyword(s):

Biliary Atresia ◽

Late Complications ◽

Long Term Survivors

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Radiotherapy Is Associated with an Accelerated Risk of Ischemic Stroke in Oral Cavity Cancer Survivors after Primary Surgery

Cancers ◽

10.3390/cancers12030616 ◽

2020 ◽

Vol 12 (3) ◽

pp. 616

Author(s):

Feng-Che Kuan ◽

Kuan-Der Lee ◽

Shiang-Fu Huang ◽

Ping-Tsung Chen ◽

Cih-En Huang ◽

...

Keyword(s):

Ischemic Stroke ◽

Oral Cavity ◽

Cox Regression ◽

Late Complication ◽

Primary Surgery ◽

Oral Cavity Carcinoma ◽

Definitive Surgery ◽

Long Term Survivors ◽

Normal Controls

The number of oral cavity carcinoma (OCC) survivors continues to increase due to advances in definitive surgery and radiation therapy (RT), however the risk of ischemic stroke is unclear in long-term survivors. In this study, survivors are defined as those who survived for >5 years after a diagnosis of OCC. They were matched at a 1:5 ratio with normal controls. Those who received surgery alone versus surgery+RT were also matched at a 1:1 ratio. From 2000 to 2005, 5172 OCC survivors who received surgery alone (n = 3205) or surgery+RT (n = 1967), and 25,860 matched normal controls were analyzed using stratified Cox regression models. Adjusted HRs (aHR) revealed that the surgery+RT group (aHR = 1.68, p < 0.001) had an elevated risk of stroke, but this was not seen in the surgery alone group (aHR = 0.99, p = 0.953). Furthermore, the age at stroke onset was at least 10 years earlier in the surgery+RT group than in the controls. In conclusion, radiotherapy increased the risk of ischemic stroke by 68% and also accelerated the onset of stroke in long-term OCC survivors after primary surgery compared with matched normal controls. Secondary prevention should include stroke as a late complication in OCC survivorship programs.

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