Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study

Background Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. Methods Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. Results A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3–23). Conclusion Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed.

show abstract

mentioning

confidence: 99%

Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…During follow-up 661 patients (90.3%) died. Median OS after diagnosis was 12 months (95% CI [11][12][13][14]. For patients who underwent a resection, the median OS was 38 months (95% CI 29-48; Fig.…”

Section: Survival Estimatesmentioning

confidence: 99%

“…3,10 Palliative resection in metastatic disease has not shown any survival benefit. 3,11 Finally, resection of pCCA is high-risk surgical procedure with a postoperative 90-day mortality rate between 5 and 18% in Western series, [12][13][14][15] and as such the possible benefit does not outweigh the risks in patients with advanced age, serious co-morbidity, or frailty. [16][17][18] The Mayo Clinic and several other centers in the United States and Europe are currently treating a select subgroup of patients with locally advanced pCCA with neoadjuvant chemoradiation and liver transplantation (LT).…”

mentioning

confidence: 99%

Eligibility for liver transplantation in patients with perihilar cholangiocarcinoma

Vugts

Gaspersz

Roos

et al. 2020

European Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background. Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. Methods. Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. Results. A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3-23). Conclusion. Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed. Perihilar cholangiocarcinoma (pCCA) is the most common malignancy of the biliary tract and arises from biliary epithelial cells at the liver hilum. 1,2 The annual incidence in Western countries is about 1-2 per 100,000. 3 The standard curative option for patients with pCCA is a radical surgical resection which is associated with a median overall survival (OS) of 40 months after resection and a 5-year survival of 30-50%. 4,5 The majority of patients with pCCA ([ 80%), however, are considered unresectable at the time of presentation. 6,7 The median survival of patients with unresectable disease is only 6 months, which can be prolonged to a median of 12 months by palliative chemotherapy including gemcitabine and cisplatinum. 6-8 Bas Groot Koerkamp and Stefan Buettner have contributed equally to this work.

show abstract

“…Endoscopically placed biliary stents are preferred to surgical hepaticojejunostomy for relief of biliary obstruction. [16,17] SEMS has an advantage over plastic stents in terms of wider diameter, faster resolution of jaundice, and less need for reinterventions.…”

Section: Biliary Stentingmentioning

confidence: 99%

Indian council of medical research consensus document for the management of pancreatic cancer

Shrikhande

Barreto

Sirohi

et al. 2019

Indian Journal of Medical and Paediatric Oncology

View full text Add to dashboard Cite

Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study

Cited by 17 publications

References 28 publications

Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma

Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma

Eligibility for liver transplantation in patients with perihilar cholangiocarcinoma

Indian council of medical research consensus document for the management of pancreatic cancer

Contact Info

Product

Resources

About