From Singapore to Vietnam to treat cholangiocarcinoma

Ho Chi Minh CityThe 34-year-old woman, after two endoscopic retrograde cholangiopancreatography to place a stent, the Singaporean doctor predicted a survival time of about 5 months, so she returned to Vietnam.

The patient was diagnosed with cholangiocarcinoma in the liver hilum, also known as Klatskin tumor, while living and working in Singapore, earlier this year. After two times of endoscopic stenting, one time of chemotherapy, costing nearly one billion VND, the patient still had biliary obstruction and had a bad prognosis, so his family brought him back to Vietnam. Five more times of chemotherapy at a hospital, the patient’s condition gradually worsened.

Nguyen The Toan, Head of the Department of Surgery, Gia An 115 Hospital, an expert with more than 20 years of experience in intervention and treatment of hepatobiliary and pancreatic diseases, with more than 10,000 cases of internal medicine. retrograde cholangioscopy, should be associated with treatment.

At the end of June, the patient was admitted to the hospital in a state of yellow skin, yellow eyes with a high fever of 39 degrees, shortness of breath, and exhaustion due to vomiting. Emergency doctors helped her stabilize her health and performed imaging tests.

According to Dr. Toan, this is a rather special case. The patient was diagnosed with cholangiocarcinoma in the liver hilum at a very young age, only 34 years old (most of the patients were over 60 years old). Therefore, the disease progresses rapidly, easily obstructs bile, damages liver cells, and the survival time is from 6 months to a year.

“The patient’s condition was a biliary tract infection due to obstruction of the previous stent placement, the size of the old stent was quite small, making it difficult for this intervention”, the doctor analyzed and decided to still do endoscopic treatment. retrograde cholangiopancreatitis (ERCP) for new, larger stents.

After nearly 60 minutes of stress, the intervention was successful, the old stent was replaced with a new one, wider, biliary circulation returned to normal.

Doctor Nguyen The Toan intervenes for the patient. Image: Hospital provides

After the intervention, the patient was awake, able to communicate, the abdominal pain and vomiting gradually improved. The next day, she could eat and drink according to a special diet, and was discharged from the hospital after 5 days of treatment, costing nearly 100 million VND. The most recent follow-up visit after one month of surgery, the patient said that he recovered better than before, no longer had vomiting or fever, and his quality of life improved significantly.

“If the complications of the disease are well controlled and controlled, the patient can live for 1.5 to 2 years, even up to 3.5 years after that, depending on the level of treatment response,” the doctor shared. shall.

Based on long-term treatment experience, Dr. Toan found that for patients with liver bile duct cancer, the right stent must be 8 cm or more. This patient’s cancerous biliary tract has reached nearly 43 cm, but the Singapore doctor only chose a short stent. The first time they put a short plastic stent, only three days later, an infection, had to do endoscopic retrograde cholangiopancreatography. Next, the doctor chose a short metal stent, so two months later the patient again had biliary obstruction.

In Vietnam, doctors choose 10 cm long stents and ERCP to save the two main biliary branches, because on the principle that cholangiocarcinoma patients will die from liver failure and infection, thus to prolong life the best. is to save liver function maintained for as long as possible. This helps minimize the process of biliary obstruction and infection.

“This is the main basis for doctors to be able to make a certain prognosis about prolonging life for patients after this treatment in Vietnam,” said the doctor.

Illustration of cholangiocarcinoma in the liver hilum, also known as Klatskin tumor.  Photo: Provided by the hospital

Illustration of cholangiocarcinoma in the liver hilum, also known as Klatskin tumor. Image: Hospital provides

According to Dr. Toan, cholangiocarcinoma in the liver hilum is a rare and dangerous disease, especially rare in young people. The disease is difficult to diagnose and treat, quickly causing dangerous complications. ERCP is an effective and low-risk method of helping patients lead a near-normal life. Since this is a minimally invasive technique, it can still be performed in severely debilitated, very elderly (80-90 years old) or severe biliary tract infections with multiple organ failure.

Klatskin tumors are characterized by three main symptoms: dyspepsia, jaundice, and anemia. Initially, the patient has indigestion due to a narrow or blocked bile flow, making bile not enough to support digestive problems. However, most patients are admitted to the hospital when the disease is at an advanced stage, the tumor invades the blood vessels or spreads far into the intrahepatic biliary tract with jaundice or anemia.

In order to prevent and detect the disease early, each person needs to pay attention to listen to their body, not to be subjective with signs of discomfort when eating, sleeping, exercising, fever, jaundice or transient pain. Timely examination can help early detection and increase the effectiveness of treatment by 50-80%.

Le Phuong


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