Abstract
Postoperative adjuvant therapy is mandatory for biliary carcinoma because of its unfavorable prognosis. The aim of this study was to evaluate the indication for postoperative adjuvant therapy in biliary carcinoma. The charts of 139 consecutive patients with biliary carcinoma (37 ampullary carcinomas, 36 distal carcinomas, 38 carcinomas of the gallbladder, and 28 hilar cholangiocarcinomas) who underwent surgical resection were retrospectively reviewed. Recurrence rates and survival rates after surgery were analyzed. Of the 139 carcinomas, the recurrence rates of International Union Against Cancer (UICC) stages IA, IB, IIA, IIB, and III cancers were 9%, 20%, 60%, 83%, and 100%, respectively. The recurrence rates of UICC stages II and III cancers were significantly higher than that of UICC stage I cancer (82% vs 13%, P < 0.001). The 5-year survival rates for patients with UICC stages IA, IB, IIA, IIB, and III cancers were 85%, 75%, 36%, 20%, and 0%, respectively. The 5-year survival rates for UICC stages II and III cancers were significantly lower than that for UICC stage I cancer (21% vs 82%, P < 0.001). Postoperative adjuvant therapy should be given to patients with UICC stages II and III biliary carcinomas because of their high rate of recurrence and the poor prognosis.
Similar content being viewed by others
References
Greenlee RT, Hill-Harmon MB, Murray T, et al. Cancer statistics, 2001. CA Cancer J Clin. 2001;51:15–36.
Okusaka T. Chemotherapy for biliary tract cancer in Japan. Semin Oncol. 2002;29:51–53.
Kim RD, Kundhal PS, McGilvray ID, et al. Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma. J Am Coll Surg. 2006;202:112–119. doi:10.1016/j.jamcollsurg.2005.08.002.
Brown KM, Tompkins AJ, Yong S, et al. Pancreaticoduodenectomy is curative in the majority of patients with node-negative ampullary cancer. Arch Surg. 2005;140:529–533. doi:10.1001/archsurg.140.6.529.
Duffy JP, Hines OJ, Liu JH, et al. Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections. Arch Surg. 2003;138:941–950. doi:10.1001/archsurg.138.9.941.
Allema JH, Reinders ME, van Gulik TM, et al. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery. 1995;117:247–253. doi:10.1016/S0039-6060(05)80197-7.
Murakami Y, Uemura K, Hayashidani Y, et al. Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. World J Surg. 2007;31:337–342. doi:10.1007/s00268-006-0224-0.
Sakamoto Y, Kosuge T, Shimada K, et al. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins. Surgery. 2005;137:396–402. doi:10.1016/j.surg.2004.10.008.
Kayahara M, Nagakawa T, Ohta T, et al. Role of nodal involvement and the periductal soft-tissue margin in middle and distal bile duct cancer. Ann Surg. 1999;229:76–83. doi:10.1097/00000658-199901000-00010.
Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg. 1996;224:463–475. doi:10.1097/00000658-199610000-00005.
Sasaki R, Itabashi H, Fujita T, et al. Related significance of extensive surgery including resection of the pancreas head for the treatment of gallbladder cancer—from the perspective of mode of lymph node involvement and surgical outcome. World J Surg. 2006;30:36–42. doi:10.1007/s00268-005-0181-z.
Yamaguchi R, Nagino M, Oda K, et al. Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma. Br J Surg. 2002;89:1130–1136. doi:10.1046/j.1365-2168.2002.02184.x.
Chijiiwa K, Tanaka M. Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery. 1994;115:751–756.
Rea DJ, Munoz-Juarez M, Farnell MB, et al. Major hepatic resection for hilar cholangiocarcinoma: analysis of 46 patients. Arch Surg. 2004;139:514–525. doi:10.1001/archsurg.139.5.514.
Hemming AW, Reed AI, Fujita S, et al. Surgical management of hilar cholangiocarcinoma. Ann Surg. 2005;241:693–702. doi:10.1097/01.sla.0000160701.38945.82.
Nimura Y, Kamiya J, Kondo S, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7:155–162. doi:10.1007/s005340050170.
Miyazaki M, Ito H, Nakagawa K, et al. Parenchyma-preserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma. J Am Coll Surg. 1999;189:575–583. doi:10.1016/S1072-7515(99)00219-7.
Alberts SR, Al-Khatib H, Mahoney MR, et al. Gemcitabine, 5-fluorouracil, and leucovorin in advanced biliary tract and gallbladder carcinoma: a North Central Cancer Treatment Group phase II trial. Cancer. 2005;103:111–118. doi:10.1002/cncr.20753.
Penz M, Kornek GV, Raderer M, et al. Phase II trial of two-weekly gemcitabine in patients with advanced biliary tract cancer. Ann Oncol. 2001;12:183–186. doi:10.1023/A:1008352123009.
Ueno H, Okusaka T, Ikeda M, et al. Phase II study of S-1 in patients with advanced biliary tract cancer. Br J Cancer. 2004;91:1769–1774. doi:10.1038/sj.bjc.6602208.
Sobin LH, Wittekind C, eds. International Union Against Cancer (UICC): TNM Classification of Malignant Tumours. 6th ed. New York: Wiley-Liss; 2002.
Japanese Society of Biliary Surgery. General Rules for Surgical and Pathological Studies on Cancer of Biliary Tract. 5th ed. Tokyo: Kanehara; 2003.
Beger HG, Treitschke F, Gansauge F, et al. Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg. 1999;134:526–532. doi:10.1001/archsurg.134.5.526.
Todoroki T, Koike N, Morishita Y, et al. Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater. Ann Surg Oncol. 2003;10:1176–1183.
Todoroki T, Kawamoto T, Koike N, et al. Treatment strategy for patients with middle and lower third bile duct cancer. Br J Surg. 2001;88:364–370. doi:10.1046/j.1365-2168.2001.01685.x.
Suzuki M, Unno M, Oikawa M, et al. Surgical treatment and postoperative outcomes for middle and lower bile duct carcinoma in Japan—experience of a single institute. Hepatogastroenterology. 2000;47:650–657.
Tsukada K, Hatakeyama K, Kurosaki I, et al. Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery. 1996;120:816–821. doi:10.1016/S0039-6060(96)80089-4.
Todoroki T, Kawamoto T, Takahashi H, et al. Treatment of gallbladder cancer by radical resection. Br J Surg. 1999;86:622–627. doi:10.1046/j.1365-2168.1999.01085.x.
Todoroki T, Kawamoto T, Koike N, et al. Radical resection of hilar bile duct carcinoma and predictors of survival. Br J Surg. 2000;87:306–313. doi:10.1046/j.1365-2168.2000.01343.x.
Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–819. doi:10.1097/00000658-199912000-00010.
Takada T, Amano H, Yasuda H, et al. Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 2002;95:1685–1695. doi:10.1002/cncr.10831.
Mehta VK, Fisher GA, Ford JM, et al. Adjuvant chemoradiotherapy for “unfavorable” carcinoma of the ampulla of Vater: preliminary report. Arch Surg. 2001;136:65–69. doi:10.1001/archsurg.136.1.65.
Bosset JF, Mantion G, Gillet M, et al. Primary carcinoma of the gallbladder. Adjuvant postoperative external irradiation. Cancer. 1989;64:1843–1847. doi:10.1002/1097-0142(19891101)64:9<1843::AID-CNCR2820640915>3.0.CO;2-N.
Mahe M, Romestaing P, Talon B, et al. Radiation therapy in extrahepatic bile duct carcinoma. Radiother Oncol. 1991;21:121–127. doi:10.1016/0167-8140(91)90084-T.
Todoroki T, Iwasaki Y, Orii K, et al. Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma. World J Surg. 1991;15:357–366. doi:10.1007/BF01658729.
Serafini FM, Sachs D, Bloomston M, et al. Location, not staging, of cholangiocarcinoma determines the role for adjuvant chemoradiation therapy. Am Surg. 2001;67:839–844.
Metzger J, Sauerbruch T, Ko Y, et al. A phase II trial of gemcitabine in gallbladder and biliary tract carcinomas. Onkologie. 1998;21:232–234. doi:10.1159/000026821.
Scheithauer W. Review of gemcitabine in biliary tract carcinoma. Semin Oncol. 2002;29:40–45.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Murakami, Y., Uemura, K., Hayasidani, Y. et al. Indication for Postoperative Adjuvant Therapy in Biliary Carcinoma Based on Analysis of Recurrence and Survival After Surgical Resection. Dig Dis Sci 54, 1360–1364 (2009). https://doi.org/10.1007/s10620-008-0492-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-008-0492-7