Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi‐institutional analysis

Reames, Bradley N.; Ejaz, Aslam; Koerkamp, Bas Groot; Alexandrescu, Sorin; Marques, Hugo P.; Aldrighetti, Luca; Maithel, Shishir K.; Pulitano, Carlo; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Martel, Guillaume; Marsh, J. Wallis; Pawlik, Timothy M.

doi:10.1002/jso.24633

Cited by 60 publications

(42 citation statements)

References 38 publications

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“…10 While tumor resection en-bloc with major vascular structures increases case complexity, studies in numerous other malignancies have shown survival rates following major vascular resection that are comparable to those without vascular involvement. [11][12][13][14] Similar findings have been reported in multiple small case series of multivisceral RPS resections performed at high volume institutions. [15][16][17][18][19][20][21] However, due to the rarity of this disease, present existing series are often small in size, include extremity sarcomas in analyses, or investigate primary leiomyosarcoma of the IVC only.…”

supporting

confidence: 84%

“…Studies have continually supported the feasibility of surgical intervention with durable oncologic outcomes in various tumor pathologies with major vascular involvement, including: pancreatic cancer, renal cell carcinoma, and intrahepatic cholangiocarcinoma . In addition, several prior studies have specifically reported on major vascular resection en‐bloc with soft tissue sarcoma.…”

Section: Discussionmentioning

confidence: 96%

“…Similarly, an R2 resection (HR = 6.52, P = 0.032) was independently associated with inferior OS along with the presence of tumor thrombus (HR 4.91, P = 0.025) ( Studies have continually supported the feasibility of surgical intervention with durable oncologic outcomes in various tumor pathologies with major vascular involvement, including: pancreatic cancer, renal cell carcinoma, and intrahepatic cholangiocarcinoma. [11][12][13][14] In addition, several prior studies have specifically reported on major vascular resection en-bloc with soft tissue sarcoma. However, many of these studies were heterogeneous with respect to tumor location (intraabdominal and extremity), and type of vascular resection (arterial vs venous, central vs peripheral).…”

Section: Operative Details and Outcomesmentioning

confidence: 99%

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Resection of retroperitoneal sarcoma en‐bloc with inferior vena cava: 20 year outcomes of a single institution

Blair

Reames

Singh

et al. 2018

Journal of Surgical Oncology

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Background: Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. Methods: Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. Results: Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IV Cresection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P = 0.519, P = 0.604). On multivariate analyses, R2 margin (OS: HR = 6.52 [95%CI: 1.18–36.09], P = 0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR = 5.07, [1.15–22.27], P = 0.031, HR = 1.28 [1.01–1.62], P = 0.014) were associated with inferior DFS. Reconstructions included graft (n = 19, 59%), patch (n = 4, 13%), primary repair (n = 6, 19%), and ligation (n = 4, 13%). Conclusions: RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.

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supporting

confidence: 84%

Section: Discussionmentioning

confidence: 96%

Section: Operative Details and Outcomesmentioning

confidence: 99%

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Resection of retroperitoneal sarcoma en‐bloc with inferior vena cava: 20 year outcomes of a single institution

Blair

Reames

Singh

et al. 2018

Journal of Surgical Oncology

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“…23,24 In a recent multiinstitutional analysis of 128 patients who underwent major vascular resections of the inferior vena cava and portal vein (21 and 98 patients, respectively), the perioperative outcomes were comparable to those achieved in 959 cases of conventional resection, suggesting that major vascular resections and reconstructions can be considered in properly selected patients, if R0 margin can be achieved. 25,26 Concerning the recommended future liver remnant (FLR) volume, iCCA does not differ from other indications for LR, with a threshold of 25% of liver volume to be preserved for patients with normal parenchyma. Conversely, patients with iCCA in the context of chronic liver disease will require a minimum FLR of 40% with no portal hypertension.…”

Section: Clinical Diagnosis and General Principles Of Surgical Considmentioning

confidence: 99%

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Mazzaferro

Gorgen

Roayaie

et al. 2020

Journal of Hepatology

203

182

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The incidence of intrahepatic cholangiocarcinoma (iCCA) is increasing worldwide. Although several advances have been made in the past decades to better understand this complex malignancy and to develop new treatment strategies, the prognosis of iCCA remains dismal. Liver resection (LR) is the mainstay of treatment but only a minority of patients are amenable to surgery. In most cases, patients with iCCA will require a major hepatectomy for complete resection of the tumour. This may be contraindicated or increase the surgical burden in patients with chronic liver disease and small remnant liver volume. Lymphadenectomy with a minimal harvest of 6 lymph nodes is considered adequate, as microscopic nodal metastases have been shown in more than 40% of patients. Current 5-year overall survival following LR is in the range of 25%-40%. For locally advanced disease not amenable to upfront LR, neoadjuvant locoregional therapies may be used with the aim of converting these patients to resectability or even to transplantation in well-selected cases. Recent studies have shown that liver transplantation (LT) might be a treatment option for patients with unresectable very-early iCCA (i.e. < − 2 cm), with survival outcomes comparable to those of hepatocellular carcinoma. In patients with unresectable, advanced tumours, confined to the liver who achieve sustained response to neoadjuvant treatment, LT may be considered an option within prospective protocols. The role of adjuvant therapies in iCCA is still under debate. Herein, we review the recent advances in the surgical treatment of iCCA and examine its correlation with locoregional therapies, adjuvant and neo-adjuvant strategies.

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“…Although resection is the cornerstone of treatment for intrahepatic cholangiocarcinoma (ICC), outcomes after operation are frequently poor. [1][2][3] In fact, even among carefully selected patients, median survival after operation can be as low at 15 to 24 months and 5-year overall survival rates range from 20% to 40%. [4][5][6] The high incidence of recurrence after operation of ICC is difficult to explain.…”

mentioning

confidence: 99%

Preoperative Risk Score and Prediction of Long-Term Outcomes after Hepatectomy for Intrahepatic Cholangiocarcinoma

Sasaki

Margonis

Andreatos

et al. 2018

Journal of the American College of Surgeons

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Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi‐institutional analysis

Abstract: Among patients with ICC, major vascular resection was not associated with worse perioperative or oncologic outcomes. Concurrent major vascular resection should be considered in appropriately selected patients with ICC undergoing hepatectomy.

Cited by 60 publications

References 38 publications

Resection of retroperitoneal sarcoma en‐bloc with inferior vena cava: 20 year outcomes of a single institution

Resection of retroperitoneal sarcoma en‐bloc with inferior vena cava: 20 year outcomes of a single institution

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Preoperative Risk Score and Prediction of Long-Term Outcomes after Hepatectomy for Intrahepatic Cholangiocarcinoma

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