The prognostic value of portal vein and hepatic artery involvement in patients with perihilar cholangiocarcinoma

Vugt, Jeroen L.A. van; Gaspersz, M.; Coelen, Robert J.S.; Vugts, Jaynee; Labeur, Tim A.; Jonge, Jeroen de; Polak, Wojciech; Busch, Olivier R.; Besselink, Marc G.; IJzermans, Jan N.M.; Nio, C. Yung; Gulik, Thomas M. van; Willemssen, F.; Koerkamp, Bas Groot

doi:10.1016/j.hpb.2017.08.025

Cited by 55 publications

(34 citation statements)

References 29 publications

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“…Portal vein resection and reconstruction may be required and may improve resection rates, R0 resection rates and survival . Hepatic artery resection and reconstruction has also been reported, though morbidity and mortality rates can be high and survival with main or unilateral hepatic artery involvement is poor . A staging laparoscopy to rule out undetected liver or peritoneal metastases is recommended with a yield above 20% in many studies .…”

Section: Perihilar Cholangiocarcinomamentioning

confidence: 99%

Surgery for cholangiocarcinoma

Cillo

Fondevila

Donadon

et al. 2019

Liver International

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Surgical resection is the only potentially curative treatment for patients with cholangiocarcinoma. For both perihilar cholangiocarcinoma (pCCA) and intrahepatic cholangiocarcinoma (iCCA), 5‐year overall survival of about 30% has been reported in large series. This review addresses several challenges in surgical management of cholangiocarcinoma. The first challenge is diagnosis: a biopsy is typically avoided because of the risk of seeding metastases and the low yield of a brush of the bile duct. However, about 15% of patients with suspected pCCA are found to have a benign diagnosis after resection. The second challenge is staging; even with the best preoperative imaging, a substantial percentage of patients has occult metastatic disease detected at staging laparoscopy or early recurrence after resection. The third challenge is an adequate volume and function of the future liver remnant, which may require preoperative biliary drainage and portal vein embolization. The fourth challenge is a complete resection: a positive bile duct margin is not uncommon because the microscopic biliary extent of disease may be more extensive than perceived on imaging. The fifth challenge is the high post‐operative mortality that has decreased in very high volume Asian centres, but remains about 10% in many Western referral centres. The sixth challenge is that even after a complete resection most patients develop recurrent disease. Recent randomized controlled trials found conflicting results regarding the benefit of adjuvant chemotherapy. The final challenge is to determine which patients with cholangiocarcinoma should undergo liver transplantation rather than resection.

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Section: Perihilar Cholangiocarcinomamentioning

confidence: 99%

Surgery for cholangiocarcinoma

Cillo

Fondevila

Donadon

et al. 2019

Liver International

Self Cite

240

224

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“…8 A multidisciplinary team diagnosed PHC based on clinical characteristics, radiological characteristics, endoscopic findings, and follow-up, if histopathological evidence was not available. 9 Patient and tumor characteristics, clinical parameters, and laboratory results were retrospectively collected from electronic patient records.…”

Section: Study Population and Data Acquisitionmentioning

confidence: 99%

“…Suspicious lymph nodes were defined as nodes larger than 1.0 cm in short-axis diameter, with central necrosis, an irregular border, or hyper-attenuation compared to liver parenchyma in the portal-venous contrast-enhancement phase. 9,10 Vascular involvement was defined as tumor contact of at least 180 degrees to the unilateral or main portal vein or hepatic artery. 9 Tumor-node-metastasis (TNM) stage was determined Tumor invades main PV or its branches bilaterally, or the common hepatic artery, or unilateral second-order biliary radicals with contralateral portal vein or hepatic artery involvement.…”

Section: Study Population and Data Acquisitionmentioning

confidence: 99%

Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for Perihilar Cholangiocarcinoma

Gaspersz

Buettner

Vugt

et al. 2020

Journal of Gastrointestinal Surgery

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Background The aim was to compare the prognostic accuracy of cross-sectional imaging of the 7th and 8th editions of the American Joint Committee on Cancer(AJCC) staging system for perihilar cholangiocarcinoma(PHC). Methods All patients with PHC between 2002 and 2014 were included. Imaging at the time of presentation was reassessed and clinical tumor-node-metastasis (cTNM) stage was determined according to the 7th and 8th editions of the AJCC staging system. Comparison of the prognostic accuracy was performed using the concordance index (c-index). Results A total of 248 PHC patients were included;45 patients(18.1%) underwent a curative-intent resection, whereas 203 patients(81.9%) did not because they were unfit for surgery or were diagnosed with locally advanced or metastatic disease during workup. Prognostic accuracy was comparable between the 7th and 8th editions (c-index 0.57 vs 0.58). For patients who underwent a curative-intent resection, the prognostic accuracy of the 8th edition (0.67) was higher than the 7th (0.65). For patients who did not undergo a curative-intent resection, the prognostic accuracy was poor in both the 7th as the 8th editions (0.54 vs 0.57). Conclusion The 7th and 8th editions of the AJCC staging system for PHC have comparable prognostic accuracy. Prognostic accuracy was particularly poor in unresectable patients.

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“…4,13 A recent study from our group found that unilateral or main hepatic artery involvement is an independent prognostic factor for survival, while portal vein involvement was not. 17 Hepatic artery involvement may be a surrogate for more advanced disease or facilitate distant spread of cancer cells. However, our study was underpowered to rule out that main portal vein involvement is a prognostic factor, because relatively few patients underwent a resection and reconstruction of the main portal vein.…”

Section: External Validationmentioning

confidence: 99%

“…Suspicious lymph nodes were defined as nodes larger than 1 cm in short-axis diameter, with central necrosis, an irregular border, or hyperattenuation compared with portal phase liver parenchyma. 17 Vascular involvement was defined as tumor contact of at least 180°to the unilateral (both homolateral and contralateral) or main portal vein or hepatic artery. Surgical success was defined as a complete (R0) resection without 90-day mortality.…”

Section: Introductionmentioning

confidence: 99%

A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma

Gaspersz

Buettner

Roos

et al. 2018

Journal of Surgical Oncology

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The prognostic value of portal vein and hepatic artery involvement in patients with perihilar cholangiocarcinoma

Abstract: Both unilateral and main HA involvement are independent poor prognostic factors for OS in patients presenting with PHC, whereas PV involvement is not.

Cited by 55 publications

References 29 publications

Surgery for cholangiocarcinoma

Surgery for cholangiocarcinoma

Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for Perihilar Cholangiocarcinoma

A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma

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