Role of a pre-operative radiological scoring system in determining resectability for potentially resectable hilar cholangiocarcinoma

Bird, Nick; McKenna, Adrian; Dunne, Declan; Francis, Ben; Fenwick, Stephen; Poston, Graeme J.; Jones, Robert; Malik, Hassan

doi:10.1016/j.ejso.2018.08.018

Cited by 6 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main reasons for unresectability were organ or peritoneum metastasis, lymph node metastasis, extended vascular involvement and extended bile duct invasion, which are listed in Table 3 [ 3 , 10 ]. Staging systems such as the MSKCC system are mostly based on these features [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…During surgical exploration, extended bile duct invasion, particularly in BC type IV patients, could attenuate the resectability rate. The resection rate of all BC types was less than 50%, and the lowest rate was for BC type IV (14.0%) [ 3 ]. In recent years, surgical performance and the R0 resection rate have been notably increased.…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of HCCA is poor because of inherent tumor malignancy and a high unresectability rate [ 2 ]. Surgical exploration is widely performed, but the total resection rate of HCCA is only approximately 50% [ 3 – 6 ]. Regardless of increased costs and a prolonged length of stay (LOS), surgery could lead to pain and mental stress in patients.…”

Section: Introductionmentioning

confidence: 99%

“…These parameters expand the prediction criteria of HCCA. With the development of radiological examinations, the accuracy of predicting resectability has been drastically increased [ 3 , 10 , 11 ]. High-resolution CT and MRI with specific sequences can optimize unresectability evaluations.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Predictive model for the intraoperative unresectability of hilar cholangiocarcinoma: Reducing futile surgical exploration

et al. 2022

View full text Add to dashboard Cite

Introduction Surgical exploration is widely performed in hilar cholangiocarcinoma (HCCA), but the intraoperative resectability rate is only 60%-80%. Exploration substantially increases pain and mental stress, and the costs and length of hospital stay are considerably increased. Identifying preoperative risk factors associated with unresectability could decrease unnecessary exploration. Materials and methods In total, 440 HCCA patients from multiple centers were enrolled. Those receiving surgical exploration were divided into the resected and unresected groups. Morphological variables including Bismuth classification, lymph node metastasis and vessel invasion were obtained from radiological exams. Logistic regression for the training cohort was used to identify risk factors for unresectability, and a nomogram was constructed to calculate the unresectability rate. A calibration curve assessed the power of the nomogram. Results Among 311 patients receiving surgical exploration, 45 (14.7%) were unresectable by intraoperative judgment. Compared with the resected group, unresected patients had similar costs (p = 0.359) and lengths of hospital stay (p = 0.439). Multivariable logistic regression of the training cohort (235 patients) revealed that CA125, Bismuth-Corlette type IV, lymph node metastasis and hepatic artery invasion were risk factors for unresectability. Liver atrophy (p = 0.374) and portal vein invasion (p = 0.114) were not risk factors. The nomogram was constructed based on the risk factors. The concordance index (C-index) values of the calibration curve for predicting the unresectability rate of the training and validation (76 patients) cohorts were 0.900 (95% CI, 0.835–0.966) and 0.829 (95% CI, 0.546–0.902), respectively. Conclusion Analysis of preoperative factors could reveal intraoperative unresectability and reduce futile surgical explorations, ultimately benefiting HCCA patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictive model for the intraoperative unresectability of hilar cholangiocarcinoma: Reducing futile surgical exploration

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Radiologically determined arterial vasculature involvement may act as a surrogate marker of local advancement and has been demonstrated to impact tumour resectability. 14 Arterial involvement by the primary tumour usually occurs concomitantly with the involvement of the portal venous vasculature due to the anatomical relationship of the vascular structures within the hilum. The effect of radiologically determined arterial involvement on OS could be indicative of multi-colinearity of effect between these covariates.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the utility of prognostic models for patients with resected hilar cholangiocarcinoma

Bird

Manu

Quinn

et al. 2019

HPB

Self Cite

View full text Add to dashboard Cite

Background: Several prognostic systems have been proposed to guide management strategies postresection for patients with hilar cholangiocarcinoma. The objective of this study was to evaluate the efficacy of these conventional prognostic models, with respect to Overall Survival (OS), on patients in a modern single-centre resectional cohort.Method: Patients diagnosed with hilar cholangiocarcinoma, referred to a supra-regional tertiary referral centre between February 2009 and February 2016, were retrospectively analysed from a prospectively held database linked to Hospital Episode Statistics and Somerset Cancer Registry data.Results: Two-hundred and one patients were assessed for suitability for surgery. Eighty-three (41%) patients considered to have potentially resectable disease underwent surgical assessment of resectability. Fifty-six (68%) patients proceeded to resection. Multivariate analysis demonstrated that preoperative Serum CA 19-9 (p = 0.007), Radiological Arterial Involvement (p = 0.005) and Amsterdam Medical Centre (AMC) prognostic model score (p = 0.032) retained significance in association with OS.Multivariate models developed from this cohort out-performed the conventional prognostic systems for OS. Conclusion:The cohort-derived multivariate models demonstrated significantly improved prognostic capability compared to conventional systems in explaining OS.

show abstract

Dyna-CT-Based Three-Dimensional Cholangiography in Biliary Duct Assessment of Hilar Cholangiocarcinoma

et al. 2020

View full text Add to dashboard Cite

Role of a pre-operative radiological scoring system in determining resectability for potentially resectable hilar cholangiocarcinoma

Cited by 6 publications

References 29 publications

Predictive model for the intraoperative unresectability of hilar cholangiocarcinoma: Reducing futile surgical exploration

Predictive model for the intraoperative unresectability of hilar cholangiocarcinoma: Reducing futile surgical exploration

Evaluation of the utility of prognostic models for patients with resected hilar cholangiocarcinoma

Dyna-CT-Based Three-Dimensional Cholangiography in Biliary Duct Assessment of Hilar Cholangiocarcinoma

Contact Info

Product

Resources

About