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Actual 5-Year Survivors After Surgical Resection of Hilar Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prevalence and characteristics of actual 5-year survivors after surgical treatment of hilar cholangiocarcinoma (HC) have not been described previously.

Methods

Patients who underwent resection for HC from 2000 to 2015 were analyzed through a multi-institutional registry from 10 U.S. academic medical centers. The clinicopathologic characteristics and both the perioperative and long-term outcomes for actual 5-year survivors were compared with those for non-survivors (patients who died within 5 years after surgery). Patients alive at last encounter who had a follow-up period shorter than 5 years were excluded from the study.

Results

The study identified 257 patients with HC who underwent curative-intent resection with an actuarial 5-year survival of 19%. Of 194 patients with a follow-up period longer than 5 years, 23 (12%) were 5-year survivors. Compared with non-survivors, the 5-year survivors had a lower median pretreatment CA 19-9 level (116 vs. 34 U/L; P = 0.008) and a lower rate of lymph node involvement (42% vs. 15%; P = 0.027) and R1 margins (39% vs. 17%; P = 0.042). However, the sole presence of these factors did not preclude a 5-year survival after surgery. The frequencies of bile duct resection alone, major hepatectomy, caudate lobe resection, portal vein or hepatic artery resection, preoperative biliary sepsis, intraoperative blood transfusion, serious postoperative complications, and receipt of adjuvant chemotherapy were comparable between the two groups.

Conclusions

One in eight patients with HC reaches the 5-year survival milestone after resection. A 5-year survival can be achieved even in the presence of traditionally unfavorable clinicopathologic factors (elevated CA 19-9, nodal metastasis, and R1 margins).

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References

  1. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis: an unusual tumor with distinctive clinical and pathological features. Am J Med. 1965;38:241–56.

    Article  CAS  PubMed  Google Scholar 

  2. Burke EC, Jarnagin WR, Hochwald SN, Pisters PW, Fong Y, Blumgart LH. Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg. 1998;228:385–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence. Ann Surg. 2008;248:73–9.

    Article  PubMed  Google Scholar 

  4. Matsuo K, Rocha FG, Ito K, et al. The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg. 2012;215:343–55.

    Article  PubMed  Google Scholar 

  5. Abd ElWahab M, El Nakeeb A, El Hanafy E, et al. Predictors of long-term survival after hepatic resection for hilar cholangiocarcinoma: a retrospective study of 5-year survivors. World J Gastrointest Surg. 2016;8:436–43.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jang JY, Kim SW, Park DJ, et al. Actual long-term outcome of extrahepatic bile duct cancer after surgical resection. Ann Surg. 2005;241:77–84.

    PubMed  PubMed Central  Google Scholar 

  7. Konstadoulakis MM, Roayaie S, Gomatos IP, et al. Aggressive surgical resection for hilar cholangiocarcinoma: is it justified? Audit of a single center’s experience. Am J Surg. 2008;196:160–9.

    Article  PubMed  Google Scholar 

  8. Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.

    Article  PubMed  Google Scholar 

  9. Silva MA, Tekin K, Aytekin F, Bramhall SR, Buckels JA, Mirza DF. Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol. 2005;31:533–9.

    Article  CAS  PubMed  Google Scholar 

  10. Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–18; discussion 819.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience. HPB Oxf. 2005;7:259–62.

    Article  Google Scholar 

  12. Belghiti J, Ogata S. Preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma. HPB Oxf. 2005;7:252–3.

    Article  Google Scholar 

  13. Cherqui D, Benoist S, Malassagne B, Humeres R, Rodriguez V, Fagniez PL. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg. 2000;135:302–8.

    Article  CAS  PubMed  Google Scholar 

  14. Lai EC, Chu KM, Lo CY, et al. Surgery for malignant obstructive jaundice: analysis of mortality. Surgery. 1992;112:891–6.

    CAS  PubMed  Google Scholar 

  15. Soares KC, Kamel I, Cosgrove DP, Herman JM, Pawlik TM. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr. 2014;3:18–34.

    PubMed  PubMed Central  Google Scholar 

  16. Edge SB, American Joint Committee on Cancer, American Cancer Society. AJCC cancer staging manual. 7th ed. Springer, New York, London, 2010.

    Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  18. Bagante F, Spolverato G, Weiss M, et al. Defining long-term survivors following resection of intrahepatic cholangiocarcinoma. J Gastrointest Surg. 2017;21:1888–97.

    Article  PubMed  Google Scholar 

  19. Ferrone CR, Brennan MF, Gonen M, et al. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2008;12:701–6.

    Article  PubMed  Google Scholar 

  20. Nagino M, Nimura Y, Nishio H, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg. 2010;252:115–23.

    Article  PubMed  Google Scholar 

  21. Noji T, Tsuchikawa T, Okamura K, et al. Concomitant hepatic artery resection for advanced perihilar cholangiocarcinoma: a case-control study with propensity score matching. J Hepatobiliary Pancreat Sci. 2016;23:442–8.

    Article  PubMed  Google Scholar 

  22. Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: Does it work or not? Surgery. 2007;141:581–8.

    Article  PubMed  Google Scholar 

  23. Neuhaus P, Thelen A, Jonas S, et al. Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma. Ann Surg Oncol. 2012;19:1602–8.

    Article  PubMed  Google Scholar 

  24. Schimizzi GV, Jin LX, Davidson JTt, et al. Outcomes after vascular resection during curative-intent resection for hilar cholangiocarcinoma: a multi-institution study from the US extrahepatic biliary malignancy consortium. HPB Oxf. 2018;20:332–9.

    Article  Google Scholar 

  25. Cavassani KA, Carson WFt, Moreira AP, et al. The post sepsis-induced expansion and enhanced function of regulatory T cells create an environment to potentiate tumor growth. Blood. 2010;115:4403–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Buettner S, Ethun CG, Poultsides G, et al. Surgical-site infection is associated with tumor recurrence in patients with extrahepatic biliary malignancies. J Gastrointest Surg. 2017;21:1813–20.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Margonis GA, Sasaki K, Andreatos N, et al. Prognostic impact of complications after resection of early stage hepatocellular carcinoma. J Surg Oncol. 2017;115:791–804.

    Article  PubMed  Google Scholar 

  28. Spolverato G, Yakoob MY, Kim Y, et al. Impact of complications on long-term survival after resection of intrahepatic cholangiocarcinoma. Cancer. 2015;121:2730–9.

    Article  PubMed  Google Scholar 

  29. Ribero D, Zimmitti G, Aloia TA, et al. Preoperative cholangitis and future liver remnant volume determine the risk of liver failure in patients undergoing resection for hilar cholangiocarcinoma. J Am Coll Surg. 2016;223:87–97.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to George A. Poultsides MD, MS, FACS.

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Tran, T.B., Ethun, C.G., Pawlik, T.M. et al. Actual 5-Year Survivors After Surgical Resection of Hilar Cholangiocarcinoma. Ann Surg Oncol 26, 611–618 (2019). https://doi.org/10.1245/s10434-018-7075-4

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  • DOI: https://doi.org/10.1245/s10434-018-7075-4

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