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2. Surgery

Author

Khuntikeo, Narong, Pugkhem, Ake, Srisuk, Tharatip, Luvira, Vor, Titapun, Attapol, Tipwaratorn, Theerawee, Thanasukarn, Vasin, Klungboonkrong, Vivian, Wongwiwatchai, Jitraporn, Allgayer, Heike, Series Editor, Khuntikeo, Narong, editor, Andrews, Ross H., editor, Petney, Trevor N., editor, and Khan, Shahid A., editor

Published
2023
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3. Surgery

Author

Khuntikeo, Narong, primary, Pugkhem, Ake, additional, Srisuk, Tharatip, additional, Luvira, Vor, additional, Titapun, Attapol, additional, Tipwaratorn, Theerawee, additional, Thanasukarn, Vasin, additional, Klungboonkrong, Vivian, additional, and Wongwiwatchai, Jitraporn, additional

Published
2023
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5. The landscape of etiological patterns of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in Thailand.

Author

Pupacdi, Benjarath, Loffredo, Christopher A., Budhu, Anuradha, Rabibhadana, Siritida, Bhudhisawasdi, Vajarabhongsa, Pairojkul, Chawalit, Sukeepaisarnjaroen, Wattana, Pugkhem, Ake, Luvira, Vor, Lertprasertsuke, Nirush, Chotirosniramit, Anon, Auewarakul, Chirayu U., Ungtrakul, Teerapat, Sricharunrat, Thaniya, Sangrajrang, Suleeporn, Phornphutkul, Kannika, Albert, Paul S., Kim, Sungduk, Harris, Curtis C., and Mahidol, Chulabhorn

Subjects
LIVER flukes, VIRAL hepatitis, HEPATOCELLULAR carcinoma, VIRUS diseases, AGRICULTURE
Abstract

Thailand is among countries with the highest global incidence and mortality rates of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). While viral hepatitis and liver fluke infections have been associated with HCC and iCCA, respectively, other environmental risk factors, overall risk factor commonality and combinatorial roles, and effects on survival have not been systematically examined. We conducted a TIGER‐LC consortium‐based population study covering all high‐incidence areas of both malignancies across Thailand: 837 HCC, 1474 iCCA, and 1112 controls (2011–2019) were comprehensively queried on lifelong environmental exposures, lifestyle, and medical history. Multivariate logistic regression and Cox proportional hazards analyses were used to evaluate risk factors and associated survival patterns. Our models identified shared risk factors between HCC and iCCA, such as viral hepatitis infection, liver fluke infection, and diabetes, including novel and shared associations of agricultural pesticide exposure (OR range of 1.50; 95% CI: 1.06–2.11 to 2.91; 95% CI: 1.82–4.63) along with vulnerable sources of drinking water. Most patients had multiple risk factors, magnifying their risk considerably. Patients with lower risk levels had better survival in both HCC (HR 0.78; 95% CI: 0.64–0.96) and iCCA (HR 0.84; 95% CI: 0.70–0.99). Risk factor co‐exposures and their common associations with HCC and iCCA in Thailand emphasize the importance for future prevention and control measures, especially in its large agricultural sector. The observed mortality patterns suggest ways to stratify patients for anticipated survivorship and develop plans to support medical care of longer‐term survivors, including behavioral changes to reduce exposures. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Compliance with enhanced recovery after surgery predicts long-term outcome after hepatectomy for cholangiocarcinoma

Author

Jongkatkorn, Chaowasaporn, primary, Luvira, Vor, additional, Suwanprinya, Chalisa, additional, Piampatipan, Kantaruthai, additional, Leeratanakachorn, Natwutpong, additional, Tipwaratorn, Theerawee, additional, Titapun, Attapol, additional, Srisuk, Tharatip, additional, Theeragul, Suapa, additional, Jarearnrat, Apiwat, additional, Thanasukarn, Vasin, additional, Pugkhem, Ake, additional, Khuntikeo, Narong, additional, Pairojkul, Chawalit, additional, Kamsa-Ard, Supot, additional, and Bhudhisawasdi, Vajarabhongsa, additional

Published
2023
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11. Benign Diseases Masquerading as Cholangiocarcinoma: Can we Differentiate before Surgery?

Author

Wannasri, Thitiporn, primary, Luvira, Vor, primary, Wongwattanachai, Arada, primary, Titapun, Attapol, primary, Srisuk, Tharatip, primary, Kamsa-ard, Supot, primary, Tipwaratorn, Theerawee, primary, Theeragul, Suapa, primary, Pugkhem, Ake, primary, Jarearnrat, Apiwat, primary, Khuntikeo, Narong, primary, Pairojkul, Chawalit, primary, and Bhudhisawasdi, Vajarabhongsa, primary

Published
2022
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17. Infrahepatic Inferior Vena Cava Clamping Reduces Blood Loss during Liver Transection for Cholangiocarcinoma

Author

Leeratanakachorn, Natwutpong, primary, Luvira, Vor, additional, Tipwaratorn, Theerawee, additional, Theeragul, Suapa, additional, Jarearnrat, Apiwat, additional, Titapun, Attapol, additional, Srisuk, Tharatip, additional, Kamsa-ard, Supot, additional, Pugkhem, Ake, additional, Khuntikeo, Narong, additional, Pairojkul, Chawalit, additional, and Bhudhisawasdi, Vajarabhongsa, additional

Published
2021
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19. Re-Rising of Total Bilirubin Level after Postoperative Day 3 (The V Pattern) Predicting Liver Failure and Survival of Patients who Underwent Hepatectomy for Cholangiocarcinoma

Author

Sawangkajohn, Weerin, primary, Luvria, Vor, additional, Leeratanakachorn, Natwutpong, additional, Tipwaratorn, Theerawee, additional, Theerakul, Suapa, additional, Jarearnrat, Apiwat, additional, Titapun, Attapol, additional, Srisuk, Tharatip, additional, Pugkhem, Ake, additional, Khuntikeo, Narong, additional, Bhudhisawasdi, Vajarabhongsa, additional, and Kamsa-ard, Supot, additional

Published
2020
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21. Cholangiocarcinoma Trends, Incidence, and Relative Survival in Khon Kaen, Thailand From 1989 Through 2013: A Population-Based Cancer Registry Study [J Epidemiol 29 (5) (2019) 197–204]

Author

Kamsa-ard, Supot, primary, Luvira, Vor, additional, Suwanrungruang, Krittika, additional, Kamsa-ard, Siriporn, additional, Luvira, Varisara, additional, Santong, Chalongpon, additional, Srisuk, Tharatip, additional, Pugkhem, Ake, additional, Bhudhisawasdi, Vajarabhongsa, additional, and Pairojkul, Chawalit, additional

Published
2020
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22. Morphological Classification of Intraductal Papillary Neoplasm of the Bile Duct with Survival Correlation

Author

Luvira, Vor, Somsap, Kulyada, Pugkhem, Ake, Eurboonyanun, Chalerm, Luvira, Varisara, Bhudhisawasdi, Vajarabhongsa, Pairojkul, Chawalit, and Ard, Supot Kamsa

Subjects
classification, Intraductal papillary neoplasm of the bile duct, survival, Research Article
Abstract

Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a specific entity for which there has been no classification that correlates clinical presentation with patient survival. We, therefore, propose a new classification based on radio-pathological appearance correlated with clinical findings including outcome. Methods: We retrospectively reviewed the medical and pathological records of 103 IPNB patients who underwent curative-intent hepatic resection between January 2008 and December 2011. A morphological classification was then created based on the presence of (a) bile duct dilatation, (b) intraductal mass(es), (c) cystic lesion(s), and (d) macro-invasion of the liver. All clinical parameters and survival were analyzed. Results: The median survival of IPNB patients was 1,728 days (95% CI: 1,485 to 1,971 days). The proposed classification predicted survival very well (log-rank test; p < 0.01). For patients with the cystic variant and micro-papillary IPNB, there were no tumor-related deaths within 3 years of surgery and median survival was not reached during the follow-up. The respective median survival times for IPNBs with unilateral intrahepatic duct dilatation, bilateral intrahepatic duct dilatation, and macro-invasion were 1,888 days (95%CI 1,118- 2,657), 673 days (95% CI: 392- 953), and 578 days (95% CI: 285- 870). Conclusion: We propose a new classification for IPNBs which not only provides a view of patients in terms of their radio-pathologic status but also should help in guiding planning of surgical procedures.

Published
2017

23. Patterns of Recurrence after Resection of Mass-Forming Type Intrahepatic Cholangiocarcinomas

Author

Luvira, Vor, Eurboonyanun, Chalerm, Bhudhisawasdi, Vajarabhongsa, Pugkhem, Ake, Pairojkul, Chawalit, Luvira, Varisara, Sathitkarnmanee, Egapong, Somsap, Kulyada, and Kamsa-ard, Supot

Subjects
recurrence, Mass forming intrahepatic cholangiocarcinoma, curative resection, survival, Research Article
Abstract

Background: Intrahepatic cholangiocarcinoma (IHCCA) is an aggressive tumor for which surgical resection is a mainstay of treatment. However, recurrence after resection is common associated with a poor prognosis. Studies regarding recurrence of mass-forming IHCCA are rare; therefore, we investigated the pattern with our dataset. Methods: We retrospectively reviewed the medical and pathological records of 50 mass-forming IHCCA patients who underwent hepatic resection between January 2004 and December 2009 in order to determine the patterns of recurrence and prognosis. All demographic and operative parameters were analyzed for their effects on recurrence-free survival. Results: The median recurrence-free survival time was 188 days (95%CI: 149-299). The respective 1-, 2-, and 3-year recurrence-free survival rates were 16.2% (95% CI: 6.6-29.4), 5.4% (95% CI: 1.0-15.8) and 2.7% (95% CI: 0.2-12.0). There was an equal distribution of recurrence at solitary and multiple sites. Univariate analysis revealed no factors related to recurrence-free survival. Conclusion: The overall survival and recurrence-free survival after surgery for mass-forming IHCCA were found to be very poor. Almost all recurrences were detected within 2 years after surgery. Adjuvant chemotherapy after surgery may add benefit in the affected patients.

Published
2016

24. Establishment of Highly Transplantable Cholangiocarcinoma Cell Lines from a Patient-Derived Xenograft Mouse Model

Author

Vaeteewoottacharn, Kulthida, primary, Pairojkul, Chawalit, additional, Kariya, Ryusho, additional, Muisuk, Kanha, additional, Imtawil, Kanokwan, additional, Chamgramol, Yaovalux, additional, Bhudhisawasdi, Vajarabhongsa, additional, Khuntikeo, Narong, additional, Pugkhem, Ake, additional, Saeseow, O-Tur, additional, Silsirivanit, Atit, additional, Wongkham, Chaisiri, additional, Wongkham, Sopit, additional, and Okada, Seiji, additional

Published
2019
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25. Cholangiocarcinoma Trends, Incidence, and Relative Survival in Khon Kaen, Thailand From 1989 Through 2013: A Population-Based Cancer Registry Study

Author

Kamsa-ard, Supot, primary, Luvira, Vor, additional, Suwanrungruang, Krittika, additional, Kamsa-ard, Siriporn, additional, Luvira, Varisara, additional, Santong, Chalongpon, additional, Srisuk, Tharatip, additional, Pugkhem, Ake, additional, Bhudhisawasdi, Vajarabhongsa, additional, and Pairojkul, Chawalit, additional

Published
2019
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27. Infrahepatic inferior vena cava clamping during liver transection for cholangiocarcinoma: a quasi – experimental study

Author

Leeratanakachorn, Natwutpong, primary, Luvira, Vor, additional, Titapun, Attapol, additional, Srisuk, Tharatip, additional, Tipwaratorn, Theerawee, additional, Kamsa-ard, Supot, additional, Pugkhem, Ake, additional, KhuntiKeo, Narong, additional, Pairojkul, Chawalit, additional, and Bhudhisawasdi, Vajarabhongsa, additional

Published
2019
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28. Predictive utility of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in intraductal papillary neoplasm of the bile duct

Author

Luvira, Vor, primary, Kamsa-ard, Supot, additional, Pugkhem, Ake, additional, Luvira, Varisara, additional, Srisuk, Tharatip, additional, Titapun, Attapol, additional, Silsirivanit, Artit, additional, Wongkham, Sopit, additional, Khuntikeo, Narong, additional, Pairojkul, Chawalit, additional, and Bhudhisawasdi, Vajarabhongsa, additional

Published
2019
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30. Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity

Author

Luvira, Vor, Pugkhem, Ake, Tipwaratorn, Theerawee, Chamgramol, Yaovalux, Pairojkul, Chawalit, and Bhudhisawasdi, Vajarabhongsa

Subjects
Article Subject, digestive system
Abstract

Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P). This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas.

Published
2016
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32. Differential Protein Expression Marks the Transition From Infection With Opisthorchis viverrini to Cholangiocarcinoma

Author

Khoontawad, Jarinya, primary, Pairojkul, Chawalit, additional, Rucksaken, Rucksak, additional, Pinlaor, Porntip, additional, Wongkham, Chaisiri, additional, Yongvanit, Puangrat, additional, Pugkhem, Ake, additional, Jones, Alun, additional, Plieskatt, Jordan, additional, Potriquet, Jeremy, additional, Bethony, Jeffery, additional, Pinlaor, Somchai, additional, and Mulvenna, Jason, additional

Published
2017
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37. Pan-viral serology uncovers distinct virome patterns as risk predictors of hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Author

Do, Whitney L., Wang, Limin, Forgues, Marshonna, Liu, Jinping, Rabibhadana, Siritida, Pupacdi, Benjarath, Zhao, Yongmei, Gholian, Heelah, Bhudhisawasdi, Vajarabhongsa, Pairojkul, Chawalit, Sukeepaisarnjaroen, Wattana, Pugkhem, Ake, Luvira, Vor, Lertprasertsuke, Nirush, Chotirosniramit, Anon, Auewarakul, Chirayu U., Ungtrakul, Teerapat, Sricharunrat, Thaniya, Sangrajrang, Suleeporn, Phornphutkul, Kannika, Budhu, Anuradha, Harris, Curtis C., Mahidol, Chulabhorn, Ruchirawat, Mathuros, and Wang, Xin Wei

Abstract

This study evaluates the pan-serological profiles of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) compared to several diseased and non-diseased control populations to identify risk factors and biomarkers of liver cancer. We used phage immunoprecipitation sequencing, an anti-viral antibody screening method using a synthetic-phage-displayed human virome epitope library, to screen patient serum samples for exposure to over 1,280 strains of pathogenic and non-pathogenic viruses. Using machine learning methods to develop an HCC or iCCA viral score, we discovered that both viral scores were positively associated with several liver function markers in two separate at-risk populations independent of viral hepatitis status. The HCC score predicted all-cause mortality over 8 years in patients with chronic liver disease at risk of HCC, while the viral hepatitis status was not predictive of survival. These results suggest that non-hepatitis viral infections may contribute to HCC and iCCA development and could be biomarkers in at-risk populations.

Published
2023
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38. Differential protein expression marks the transition from infection with Opisthorchis viverrini to cholangiocarcinoma

Author

Khoontawad, Jarinya, primary, Pairojkul, Chawalit, additional, Rucksaken, Rucksak, additional, Pinlaor, Porntip, additional, Wongkham, Chaisiri, additional, Yongvanit, Puangrat, additional, Pugkhem, Ake, additional, Jones, Alun, additional, Plieskatt, Jordan, additional, Potriquet, Jeremy, additional, Bethony, Jeffery, additional, Pinlaor, Somchai, additional, and Mulvenna, Jason, additional

Published
2016
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44. Differential Protein Expression Marks the Transition From Infection With Opisthorchis viverrinito Cholangiocarcinoma*

Author

Khoontawad, Jarinya, Pairojkul, Chawalit, Rucksaken, Rucksak, Pinlaor, Porntip, Wongkham, Chaisiri, Yongvanit, Puangrat, Pugkhem, Ake, Jones, Alun, Plieskatt, Jordan, Potriquet, Jeremy, Bethony, Jeffery, Pinlaor, Somchai, and Mulvenna, Jason

Abstract

Parts of Southeast Asia have the highest incidence of intrahepatic cholangiocarcinoma (CCA) in the world because of infection by the liver fluke Opisthorchis viverrini(Ov). Ov-associated CCA is the culmination of chronic Ov-infection, with the persistent production of the growth factors and cytokines associated with persistent inflammation, which can endure for years in Ov-infected individuals prior to transitioning to CCA. Isobaric labeling and tandem mass spectrometry of liver tissue from a hamster model of CCA was used to compare protein expression profiles from inflammed tissue (Ovinfected but not cancerous) versuscancerous tissue (Ov-induced CCA). Immunohistochemistry and immunoblotting were used to verify dysregulated proteins in the animal model and in human tissue. We identified 154 dysregulated proteins that marked the transition from Ov-infection to Ov-induced CCA, i.e.proteins dysregulated during carcinogenesis but not Ov-infection. The verification of dysregulated proteins in resected liver tissue from humans with Ov-associated CCA showed the numerous parallels in protein dysregulation between human and animal models of Ov-induced CCA. To identify potential circulating markers for CCA, dysregulated proteins were compared with proteins isolated from exosomes secreted by a human CCA cell line (KKU055) and 27 proteins were identified as dysregulated in CCA and present in exosomes. These data form the basis of potential diagnostic biomarkers for human Ov-associated CCA. The profile of protein dysregulation observed during chronic Ovinfection and then in Ov-induced CCA provides insight into the etiology of an infection-induced inflammation-related cancer.

Published
2017
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45. Preoperative Portal Vein Embolization before Major Hepatic Resection in Bile Duct Tumor: A Preliminary Report.

Author

Pugkhem, Ake, Loapaiboon, Vallop, Bhudhisawasdi, Vajarabhongsa, Khuntikeo, Narong, and Uttaravichien, Thongueb

Subjects
*LIVER diseases, *MORTALITY, *HYPERTROPHY, *HEPATECTOMY, *CHOLANGIOCARCINOMA
Abstract

Introduction: Major hepatic resections in patients with chronic parenchymal or cholestatic liver diseases are associated with significant morbidity and mortality. Preoperative portal vein embolization to induce hypertrophy of future liver remnant may result in the increase of operative safety. Materials and Methods: The medical records of 8 patients who underwent major hepatectomies after portal vein embolization from 2003 to 2004 were retrieved. Demographic data, technique of portal vein embolization, estimated standard liver volume, post portal vein embolization future liver remnant volume, morbidity and mortality were collected and analysed. Results: Four men and 4 women (average age 56.6 years) with liver diseases including 6 intraductal papillary mucinous tumours of bile duct, 4 benign lesions, 2 malignant lesions and 2 hilar cholangiocarcinoma were included in this study. Left percutaneous transhepatic biliary drainage was performed before right portal vein embolization in 3 cases. Migration of embolized substance to contralateral lobe occurred in 1 case. The average ratio of future liver remnant volume and estimated standard liver volume was 52.75%. Major hepatic resection was performed in all. There was subphrenic collection in 1 case which was successfully treated by percutaneous drainage. No postoperative liver failure or mortality was encountered. Conclusions: Preoperative portal vein embolization before major hepatic resection is safe. Atrophy of the affected lobe makes it easier in mobilization and control of bleeding. [ABSTRACT FROM AUTHOR]

Published
2008

49. Co-existence of intraductal papillary neoplasm of the bile duct and Opisthorchis viverrini.

Author

Luvira V, Tipwaratorn T, and Pugkhem A

Subjects
Animals, Bile Ducts, Bile Ducts, Intrahepatic diagnostic imaging, Humans, Bile Duct Neoplasms complications, Bile Duct Neoplasms diagnostic imaging, Bile Duct Neoplasms surgery, Cholangiocarcinoma diagnostic imaging, Cholangiocarcinoma surgery, Opisthorchiasis complications, Opisthorchis
Abstract

Highlight Luvira and colleagues present images of the intraoperative findings of Opisthorchis viverrini coexistent with intraductal papillary neoplasm of the bile duct. Along with evidence from previous reports, these findings suggest that Opisthorchis viverrini may play some role in the tumorigenesis of intraductal papillary neoplasm of the bile duct., (© 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

Published
2022
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50. Programmed Death-Ligand 1 (PD-L1) Expression Associated with a High Neutrophil/Lymphocyte Ratio in Cholangiocarcinoma

Author

Sangkhamanon S, Jongpairat P, Sookprasert A, Wirasorn K, Titapun A, Pugkhem A, Ungareevittaya P, and Chindaprasirt J

Abstract

Background: Effective treatments for cholangiocarcinoma (CCA) are still lacking. There are promising results of checkpoint inhibitor programmed cell death ligand-1 (PD-L1) activities in early phase trials. This study aimed to investigate the expression of PD-L1 and its relation to possible treatments for CCA. Methods: Formalin-fixed paraffin-embedded tumor samples from 46 patients with cholangiocarcinoma were retrieved. PD-L1 expression was evaluated by immunohistochemistry using anti-PD-L1 antibody, clone 5H1. A PD-L1 positive response on tumor cells was defined as >1% of tumor cell membranes stained. The association between PD-L1, clinico-pathological characteristics was analyzed using Fisher’s exact test, and survival analysis was done with the Cox regression model. Results: Out of 46 samples, 32 (70%) had positive PD-L1 expression in tumor cell membranes. The median level of PD-L1 expression was 1.75% (0-34.7). PD-L1 expression was significantly associated with stage IV disease (OR 3.98, p=0.046) and a high neutrophil/lymphocyte ratio (OR 5.36, p=0.018). PD-L1 positivity was associated with worse overall survival compared with those with a PD-L1 negative tumor but did not reach a level of significance (7.2 vs. 7.9 months, p=0.32). Conclusion: PD-L1 is widely expressed in CCA but was not predictive for overall survival. PD-L1 positivity was (7.2 and 7.9 months, p=0.32). Significantly associated with stage IV disease and a high neutrophil/lymphocyte ratio., (Creative Commons Attribution License)

Published
2017
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