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Cholangiographic Tumor Classification for Simple Patient Selection Prior to Hepatopancreatoduodenectomy for Cholangiocarcinoma

  • Yoshitaka Toyoda
  • Tomoki EbataEmail author
  • Takashi Mizuno
  • Yukihiro Yokoyama
  • Tsuyoshi Igami
  • Junpei Yamaguchi
  • Shunsuke Onoe
  • Nobuyuki Watanabe
  • Masato Nagino
Hepatobiliary Tumors
  • 17 Downloads

Abstract

Background

Hepatopancreatoduodenectomy (HPD) is employed for patients with laterally advanced cholangiocarcinoma. However, the survival benefit of this extended approach remains controversial. The aim of this study is to identify a tumor feature benefiting from HPD from the standpoint of long-term survival.

Patients and Methods

Patients with cholangiocarcinoma who underwent HPD with curative intent between 2001 and 2017 were retrospectively analyzed. Tumors were radiologically classified by preoperative cholangiogram. Diffuse type was defined as significant tumor/stricture located from the hilar to intrapancreatic duct; localized type was defined as tumor otherwise. Univariable and multivariable analyses were performed to identify prognostic indicators.

Results

Of 100 study patients, 28 (28%) patients had diffuse tumor type, while the remaining 72 (72%) patients had localized tumors. The former group showed significantly longer lateral length (43 versus 22 mm, P < 0.001) and more frequent pancreatic invasion (50% versus 32%, P = 0.110), advanced T classification (64% versus 49%, P = 0.185), and nodal metastasis (57% versus 47%, P = 0.504), compared with the latter group. The survival for patients with diffuse tumor type was significantly worse than that for patients with localized tumor type, with 5-year survival rates of 59.0% versus 26.3%, respectively (P = 0.003). Multivariable analysis identified four independent factors deteriorating long-term survival: cholangiographic diffuse tumor (P = 0.021), higher age (P = 0.020), percutaneous biliary drainage (P = 0.007), and portal vein resection (P = 0.007).

Conclusions

Presurgical cholangiographic classification, diffuse or localized type, is a tumor-related factor closely associated with survival probability; therefore, it may be a useful feature for patient selection prior to HPD for cholangiocarcinoma.

Notes

Disclosure

The authors declare that they have no conflict of interest of this work.

Supplementary material

10434_2019_7457_MOESM1_ESM.tif (100 kb)
Supplemental Fig. 1. Diagram showing the patients who underwent hepatopancreatoduodenectomy for cholangiocarcinoma. HPD, hepatopancreatoduodenectomy; Hx, hepatectomy; PD, pancreatoduodenectomy (TIFF 100 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Yoshitaka Toyoda
    • 1
  • Tomoki Ebata
    • 1
    Email author
  • Takashi Mizuno
    • 1
  • Yukihiro Yokoyama
    • 1
  • Tsuyoshi Igami
    • 1
  • Junpei Yamaguchi
    • 1
  • Shunsuke Onoe
    • 1
  • Nobuyuki Watanabe
    • 1
  • Masato Nagino
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan

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