R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer

Abstract

Background There is a need for better management strategies to improve survival and quality of life in patients with biliary tract cancer (BTC). Aim To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC. Method We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n=237, gallbladder cancer n=84) seen in a tertiary referral cancer centre between 1998–2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox regression analysis was used to determine independent prognostic factors. Results 89 (28%) patients underwent surgical intervention with curative intent, of which 38% had R0-resections. Amongst the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year-survival 14%). R0-resective surgery conferred the most favourable outcome (3-year-survival 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum CA19-9, distant metastasis and vascular involvement were independent prognostic indicators of survival. Conclusion In this large UK series of BTC, palliative PDT resulted in similar survival to those with curatively intended R1/R2-resections. Surgery conferred a survival advantage only in patients with R0-resection margins, emphasising the need for accurate pre-operative staging.

Safety and long term efficacy of porfimer sodium photodynamic therapy in locally advanced biliary tract carcinoma

“…Witzigmann et al reported a comparable survival in patients with attempted curative surgery but positive (R1/R2) resection margins and those treated palliatively with PDT plus stenting [17] — similar findings to our own group [18]. Thus, a careful selection of patients for PDT may also avoid the morbidity and mortality associated with noncurative surgical resection.…”

Cholangiocarcinoma—controversies and challenges

“…In two studies, palliative photodynamic therapy has comparable survival in patients who underwent resection with curative intent, but had residual tumor (R1 or R2). 73,74 Although these approaches do not detract from an aggressive surgical approach, they further emphasize the need and value of accurate preoperative staging.…”

Current Status of Endoscopic Treatment of Advanced Hilar Cholangiocarcinoma

“…Studies have shown that 15-29.5% of patients with CCA were deemed unresectable at the time of diagnosis [24][25][26]. In addition, in some institutes, patients with potentially resectable CCA would undergo laparoscopic evaluation prior to laparotomy.…”