Evaluating the Clinical Applicability of the European Staging System for Perihilar Cholangiocarcinoma

Ismael, Hishaam; Loyer, Evelyne M.; Kaur, Harmeet; Conrad, Claudius; Vauthey, Jean Nicolas; Aloia, Thomas A.

doi:10.1007/s11605-016-3075-5

Cited by 11 publications

(14 citation statements)

References 19 publications

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“…At the moment, the use of preoperative biliary drainage and portal vein embolization in curative-intent surgery for PHC is higher in East Asian surgical centres (27)(28)(29)(30)(31)(32)(33)(82)(83)(84)(85), compared to the Western centres (34,35,40,43,52,79,(86)(87)(88)(89)(90).…”

Section: Discussion Discussionmentioning

confidence: 99%

“…90) (table 2). In the present series major hepatectomies were used in 80.7% of patients, and portal vein resection and reconstruction was performed in 16.7% of patients.The use of preoperative biliary drainage in recent series of Western patients with curative-intent surgery for PHC is reported to be 45% -88.2%, while portal vein embolization was used in 0% -25.5%(34,35,43,52,79,(86)(87)(88)(89)(90)(92)(93)(94)(95) (table 2). In the present cohort biliary drainage was used in 26% of patients and no patient…”

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confidence: 99%

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Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Dumitraşcu¹,

Brasoveanu²,

Stroescu³

et al. 2018

SGO

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Introduction:The knowledge of current approach and outcomes of curative-intent surgery for perihilar cholangiocarcinoma (PHC) has been highlighted in studies of the literature including mainly East Asian and Western patients. Thus, papers presenting the curative-intent surgery in East Europe are scarce. The study aims to present the operative management and outcomes of curative-intent surgery for PHC in an East European institutional experience. Patients and methods: The data of all patients with curative-intent surgery for PHC between 1996 and 2017 were retrospectively reviewed from a prospective maintained electronic database at our Department of Surgery. The assessment was made for the operative management and early and late outcomes. Results: Liver resections were performed in 80.7% of patients, with caudate lobectomies in 64.7% of cases. Vascular resections were performed in 19.4% of patients. Preoperative biliary drainage was performed in 26% of patients. Negative resection margins were obtained in 76.7% of patients. Overall and severe morbidity rates were 57.3% and 24%, respectively. Postoperative bile leak, liver failure and hemorrhage rates were 31.3%, 24.7% and 10%, respectively. The 90-day mortality rate was 6%. The median overall and disease-free survival times were 26 months and 21 months, respectively. Conclusion: The standard approach for curative-intent surgery for PHC implies bile duct resection associated with major hepatectomies, including caudate lobectomy. Expertise in referral surgical centers of East Europe is associated with morbidity, mortality and overall survival rates comparable with those reported in Western centres, despite low rate of preoperative biliary drainage and no use of portal vein embolization. Improvements of preoperative optimization with portal vein embolization and biliary drainage may potentially lead to better early and long-term outcomes.

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Section: Discussion Discussionmentioning

confidence: 99%

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confidence: 99%

Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Dumitraşcu¹,

Brasoveanu²,

Stroescu³

et al. 2018

SGO

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“…pCCA was defined as cholangiocarcinoma that involve/near the biliary confluence of the right and left hepatic duct and was located to the area between the secondary branch of bile ducts and the insertion of the cystic duct into the common bile duct [ 4 ]. Radical surgery occupied the only curative option for patients with extrahepatic cholangiocarcinoma, with a 5-year survival rate ranging from 9 to 41% [ 11 – 14 ]. Recently, therapeutic programs were extended to liver transplantation in highly select cases [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection

Zhao

Zhang

et al. 2020

BMC Cancer

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Background Both the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) had the same definition for T2a and T2b. But the value of this classification as prognostic factor remains unclear. Methods 178 patients with stage T2a or T2b who underwent curative intent resection for pCCA between Jan 2010 and Dec 2018 were enrolled. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate Cox regression analysis. The overall survival (OS) were calculated by Kaplan-Meier method. Results There was no significant difference in OS between T2a and T2b groups, and the median OS duration were 37 and 31 months ( P = 0.354). Both the 7th and 8th edition of the AJCC TNM staging demonstrated a poor prognostic predictive performance. High level of preoperative AST (≥85.0 IU/L) and CA19–9 (≥1000 U/mL), vascular resection and lower pathological differentiation of the tumor were the independent predictors for poor survival after resection. Conclusion The newly released 8th edition of AJCC staging system demonstrated a poor ability to discriminate the prognosis of patients with stage T2a and T2b pCCA after resection.

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“…[4] Radical surgery occupied the only curative option for patients with extrahepatic cholangiocarcinoma, with a 5-year survival rate ranging from 9% to 41%. [11][12][13][14] Recently, therapeutic programs were extended to liver transplantation in highly select cases. [15] Accurate stage is crucial to clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection

Zhao

Zhang

et al. 2020

Preprint

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Background: Both the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) had the same definition for T2a and T2b. But the value of this classification as prognostic factor remains unclear. Methods: 178 patients with stage T2a or T2b who underwent curative intent resection for pCCA between Jan 2010 and Dec 2018 were enrolled. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate Cox regression analysis. The overall survival (OS) were calculated by Kaplan-Meier method.Results: There was no significant difference in OS between T2a and T2b groups，and the median OS duration were 37 and 31 months (P=0.354). Both the 7th and 8th edition of the AJCC TNM staging demonstrated a poor prognostic predictive performance. High level of preoperative AST (≥85.0IU/L) and CA19-9 (≥1000 U/mL), vascular resection and lower pathological differentiation of the tumor were the independent predictors for poor survival after resection.Conclusion: The newly released 8th edition of AJCC staging system demonstrated a poor ability to discriminate the prognosis of patients with stage T2a and T2b pCCA after resection.

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Evaluating the Clinical Applicability of the European Staging System for Perihilar Cholangiocarcinoma

Cited by 11 publications

References 19 publications

Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Operative Management and Outcomes of 150 Patients with Curative-intent Surgery for Perihilar Cholangiocarcinomas: A Single Institute East European Perspective

Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection

Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection

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