Surgical Treatment of 144 Cases of Hilar Cholangiocarcinoma Without Liver‐Related Mortality

Furusawa, Norihiko; Kobayashi, Adam; Yokoyama, Tetsuji; Shimizu, Akira; Motoyama, Hiroaki; Miyagawa, S.

doi:10.1007/s00268-013-2394-x

Cited by 50 publications

(52 citation statements)

References 61 publications

(71 reference statements)

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“…(6, 14–17) Patients with a negative margin were divided between a narrow and a wide margin. A narrow margin was defined as an initial positive margin (typically on frozen section), but a negative definitive margin with additional resection.…”

Section: Methodsmentioning

confidence: 99%

Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection

Koerkamp

Wiggers

Allen

et al. 2015

Journal of the American College of Surgeons

154

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Background To investigate the rate and pattern of recurrence after curative intent resection of perihilar cholangiocarcinoma (PHC). Study design Patients were included from two prospectively maintained databases. Recurrences were categorized by site. Time to recurrence and recurrence free survival (RFS) were estimated using the Kaplan-Meier method. Cox proportional hazards modeling was used to identify independent poor prognostic factors. Results Between 1991 and 2012, 306 consecutive patients met the inclusion criteria. The median overall survival was 40 months. A recurrence was diagnosed in 177 patients (58%). An initial local recurrence was found in 26% of patients: liver hilum (11%), hepaticojejunostomy (8%), liver resection margin (8%), or distal bile duct remnant (2%). An initial distant recurrence was observed in 40% of patients: retroperitoneal lymph nodes (14%), intrahepatic away from the resection margin (13%), peritoneum (12%), and lungs (8%). Only 18% of patients had an isolated initial local recurrence. The estimated overall recurrence rate was 76% at 8 years. After a recurrence free period of 5 years, 28% of patients developed a recurrence in the next 3 years. Median RFS was 26 months. Independent prognostic factors for RFS were resection margin, lymph node status, and tumor differentiation. Only node-positive PHC precluded RFS beyond 7 years. Conclusions PHC will recur in most patients (76%) after resection, emphasizing the need for better adjuvant strategies. The high recurrence rate up to eight years justifies prolonged surveillance. Only patients with an isolated initial local recurrence (18%) may have benefited from a more extensive resection or liver transplantation. Node-positive PHC appears incurable.

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Section: Methodsmentioning

confidence: 99%

Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection

Koerkamp

Wiggers

Allen

et al. 2015

Journal of the American College of Surgeons

154

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“…7,37 A decreased need for blood transfusions were associated with low mortality and morbidity rates. 7,37 The impact of portal vein resection during major hepatectomies for PHC is controversial. Thus, most of the studies did not associate venous resection with increased mortality or morbidity rates, 5,6,9,11,16,23 while others showed increased postoperative complication rates.…”

Section: + Modelmentioning

confidence: 99%

Major hepatectomies for perihilar cholangiocarcinoma: Predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions

Dumitraşcu

Brasoveanu

Stroescu

et al. 2016

Asian Journal of Surgery

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Clinically relevant morbidity rates after major hepatectomies for perihilar cholangiocarcinoma are high. Liver failure represents the main complication and is correlated with the number of transfused blood units. A patient with increased bilirubinemia appears to have a high risk for postoperative hemorrhage. Biliary drainage and portal vein resection does not appear to have a detrimental effect on morbidities. Neutrophil-to-lymphocyte ratio is a novel independent predictor for severe morbidity after major hepatectomies for perihilar cholangiocarcinoma and may contribute to better and informed decision-making.

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“…Lymph node (LN) metastasis has been showed as one of the most significantly prognostic factors in PHC 2, 8–12 . The 5-year survival rate of patients with node-positive disease is less than 25% 13–15 .…”

Section: Introductionmentioning

confidence: 99%

Patterns and prognostic value of lymph node dissection for resected perihilar cholangiocarcinoma

Mao

Liu

Sun

et al. 2016

J of Gastro and Hepatol

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Background Lymph node metastasis is a major prognostic factor for perihilar cholangiocarcinoma (PHC). However, prognostic significance of extent of node dissection, lymph node ratio (LNR), number and location of positive nodes remain unclear. We aimed to evaluate whether node status, LNR, number or location of positive nodes are independent factors for staging in PHC, and to determine the minimum requirements for node examination. Methods The Surveillance, Epidemiology, and End Results database was used to identify 1,116 resected PHCs from 1998 to 2008. The correlation between nodal status and survival was analyzed retrospectively. Results Lymph node metastasis occurred in 43.4% patients and was an independent predictor for overall survival (OS) and cancer-specific survival (CSS). No survival benefit was observed for an increasing number of node retrieval in node-positive patients. However, in node-negative patients, ≥13 node dissection was of more survival benefit than 3≤total lymph node count (TLNC) ≤12 and TLNC<3 (5-year OS: 52.8% vs. 39.7% vs. 26.3%, P=0.001; 5-year CSS: 60.6% vs. 46.3% vs. 30.0%, P=0.001). No difference in survival between patients with regional and distant node involvement was found. Survival for patients with >3 positive nodes was significantly worse than that for those with 3 or less (RR: 1.466, P=0.001). And patients with LNR>0.27 also had unfavorable prognosis (RR: 1.376:, P=0.001). Conclusions To adequately assess nodal status of this life-threatening disease, 13 or more nodes retrieval should be considered. Number of positive nodes and LNR rather than location of metastatic nodes may be defined as parameters for staging of PHC.

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Surgical Treatment of 144 Cases of Hilar Cholangiocarcinoma Without Liver‐Related Mortality

Cited by 50 publications

References 61 publications

Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection

Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection

Major hepatectomies for perihilar cholangiocarcinoma: Predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions

Patterns and prognostic value of lymph node dissection for resected perihilar cholangiocarcinoma

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