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The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases.

Publication ,  Journal Article
de Jong, MC; Marques, H; Clary, BM; Bauer, TW; Marsh, JW; Ribero, D; Majno, P; Hatzaras, I; Walters, DM; Barbas, AS; Mega, R; Schulick, RD ...
Published in: Cancer
October 1, 2012

UNLABELLED: BACKGROUND. Surgical strategy for hilar cholangiocarcinoma often includes hepatectomy, but the role of portal vein resection (PVR) remains controversial. In this study, the authors sought to identify factors associated with outcome after surgical management of hilar cholangiocarcinoma and examined the impact of PVR on survival. METHODS: Three hundred five patients who underwent curative-intent surgery for hilar cholangiocarcinoma between 1984 and 2010 were identified from an international, multi-institutional database. Clinicopathologic data were evaluated using univariate and multivariate analyses. RESULTS: Most patients had hilar cholangiocarcinoma with tumors classified as T3/T4 (51.1%) and Bismuth-Corlette type II/III (60.9%). Resection involved extrahepatic bile duct resection (EHBR) alone (26.6%); or hepatectomy and EHBR without PVR (56.7%); or combined hepatectomy, EHBR, and PVR (16.7%). Negative resection (R0) margin status was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 64.2%; with PVR, 66.7%) versus EHBR alone (54.3%; P < .001). The median number of lymph nodes assessed was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 6 lymph nodes; with PVR, 4 lymph nodes) versus EHBR alone (2 lymph nodes; P < .001). The 90-day mortality rate was lower for patients who underwent EHBR alone (1.2%) compared with the rate for patients who underwent hepatectomy plus EHBR (without PVR, 10.6%, with PVR, 17.6%; P < .001). The overall 5-year survival rate was 20.2%. Factors that were associated with an adverse prognosis included lymph node metastasis (hazard ratio [HR], 1.79; P = .002) and R1 margin status (HR, 1.81; P < .001). Microscopic vascular invasion did not influence survival (HR, 1.23; P = .19). Among the patients who underwent hepatectomy plus EHBR, PVR was not associated with a worse long-term outcome (P = .76). CONCLUSIONS: EHBR alone was associated with a greater risk of positive surgical margins and worse lymph node clearance. The current results indicated that hepatectomy should be considered the standard treatment for hilar cholangiocarcinoma, and PVR should be undertaken when necessary to extirpate all disease. Combined hepatectomy, EHBR, and PVR can offer long-term survival in some patients with advanced hilar cholangiocarcinoma.

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

October 1, 2012

Volume

118

Issue

19

Start / End Page

4737 / 4747

Location

United States

Related Subject Headings

  • Vascular Neoplasms
  • Treatment Outcome
  • Time Factors
  • Radiotherapy, Adjuvant
  • Portal Vein
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Invasiveness
  • Neoadjuvant Therapy
  • Middle Aged
 

Citation

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de Jong, M. C., Marques, H., Clary, B. M., Bauer, T. W., Marsh, J. W., Ribero, D., … Pawlik, T. M. (2012). The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer, 118(19), 4737–4747. https://doi.org/10.1002/cncr.27492
Jong, Mechteld C. de, Hugo Marques, Bryan M. Clary, Todd W. Bauer, J Wallis Marsh, Dario Ribero, Pietro Majno, et al. “The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases.Cancer 118, no. 19 (October 1, 2012): 4737–47. https://doi.org/10.1002/cncr.27492.
de Jong MC, Marques H, Clary BM, Bauer TW, Marsh JW, Ribero D, et al. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer. 2012 Oct 1;118(19):4737–47.
de Jong, Mechteld C., et al. “The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases.Cancer, vol. 118, no. 19, Oct. 2012, pp. 4737–47. Pubmed, doi:10.1002/cncr.27492.
de Jong MC, Marques H, Clary BM, Bauer TW, Marsh JW, Ribero D, Majno P, Hatzaras I, Walters DM, Barbas AS, Mega R, Schulick RD, Choti MA, Geller DA, Barroso E, Mentha G, Capussotti L, Pawlik TM. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer. 2012 Oct 1;118(19):4737–4747.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

October 1, 2012

Volume

118

Issue

19

Start / End Page

4737 / 4747

Location

United States

Related Subject Headings

  • Vascular Neoplasms
  • Treatment Outcome
  • Time Factors
  • Radiotherapy, Adjuvant
  • Portal Vein
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Invasiveness
  • Neoadjuvant Therapy
  • Middle Aged