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

Gaspersz, M.; Buettner, Stefan; Roos, Eva; Vugt, Jeroen L.A. van; Coelen, R.J.; Vugts, Jaynee; Wiggers, Jimme K.; Allen, Peter J.; Besselink, Marc G.; Busch, Olivier R.; Belt, Eric; D’Angelica, Michael I.; DeMatteo, Ronald P.; Jonge, Jeroen de; Kingham, T. Peter; Polak, Wojciech; Willemssen, F.; Gulik, Thomas M. van; Jarnagin, William R.; IJzermans, Jan N.M.; Koerkamp, Bas Groot

doi:10.1002/jso.25174

Cited by 19 publications

(10 citation statements)

References 30 publications

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“…These incidences are in contrast to 6.2%, 8 17%-45%, 2,11 and 23% 21 respectively, in Western countries. Nonetheless, our resectability rate of 69.7% exceeded that in other studies, 22,23 which can be explained by the proactive use of left hepatic trisectionectomy, hepatic artery resection, or pancreatoduodenectomy for locally advanced tumors, 16,24 as is common in Japan. 7 Otherwise, considerable numbers of patients would have been treated as unresectable.…”

Section: Discussioncontrasting

confidence: 70%

“…There are some studies proposing a new preoperative staging scheme to stratify survival, 21,22,25 most of which involve radiologic findings, including tumor diameter and conditional factors, as determinants. Thus, tumor size is a well‐known prognostic factor in perihilar cholangiocarcinoma and a major selection criterion for liver transplantation 26,27 .…”

Section: Discussionmentioning

confidence: 99%

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Superiority of clinical American Joint Committee on Cancer T classification for perihilar cholangiocarcinoma

Yamada

Mizuno

Yamaguchi

et al. 2021

J Hepato Biliary Pancreat

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Perihilar cholangiocarcinoma is a devastating disease, with frequently metastatic and/or locally advanced disease at initial presentation. 1 Although surgical resection is the first choice for a potential curative approach, the resection rate remains low, ranging from 25% to 40% 2,3 due to the complex anatomy, the extensive nature of the resection, and high risk. Subsequently, a considerable percentage of the patient population is compelled to receive systemic chemotherapy with gemcitabine and cisplatin, resulting in a short median survival time (MST) of approximately

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Superiority of clinical American Joint Committee on Cancer T classification for perihilar cholangiocarcinoma

Yamada

Mizuno

Yamaguchi

et al. 2021

J Hepato Biliary Pancreat

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“… 17 Considering the 310 resections performed over 9 years in this study, the number of pCCA per center per year is estimated at 2 to 3 procedures. Since there are a few Dutch centres that report an annual higher volume of pCCA resections, 18 , 19 the number of resections in some centres is likely much less that the annual 2 to 3. Mortality rate within 90‐days after surgery was 14% in this nationwide study, which corresponds to the mortality reported in series from experienced Western centres.…”

Section: Discussionmentioning

confidence: 99%

“…Discussion of these patients with regional experts in might increase the accuracy of staging, currently about half of all patients who undergo explorative surgery are found to have unresectable disease. 18 , 29 , 30 Regional multidisciplinary meetings might help to increase the number of patients referred for curative resection, but also help select patients that might be eligible for palliative systemic therapy or other experimental palliative local therapies. Further centralization of the resection for pCCA that are currently performed across 14 centres to a handful of hospitals might help to decease the 90‐day mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Nationwide treatment and outcomes of perihilar cholangiocarcinoma

Keulen

Franssen

Geest

et al. 2021

Liver International

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Background Perihilar cholangiocarcinoma (pCCA) is a rare tumour that requires complex multidisciplinary management. All known data are almost exclusively derived from expert centres. This study aimed to analyse the outcomes of patients with pCCA in a nationwide cohort. Methods Data on all patients diagnosed with pCCA in the Netherlands between 2010 and 2018 were obtained from the Netherlands Cancer Registry. Data included type of hospital of diagnosis and the received treatment. Outcomes included the type of treatment and overall survival. Results A total of 2031 patients were included and the median overall survival for the overall cohort was 5.2 (95% CI 4.7‐5.7) months. Three‐hundred‐ten (15%) patients underwent surgical resection, 271 (13%) underwent palliative systemic treatment, 21 (1%) palliative local anti‐cancer treatment and 1429 (70%) underwent best supportive care. These treatments resulted in a median overall survival of 29.6 (95% CI 25.2‐34.0), 12.2 (95% CI 11.0‐13.3), 14.5 (95%CI 8.2‐20.8) and 2.9 (95% CI 2.6‐3.2) months respectively. Resection rate was 13% in patients who were diagnosed in non‐academic and 32% in academic centres (P < .001), which resulted in a survival difference in favour of academic centres. Median overall survival was 9.7 (95% CI 7.7‐11.7) months in academic centres compared to 4.9 (95% CI 4.3‐5.4) months in non‐academic centres (P < .001). Conclusions In patients with pCCA, resection rate and overall survival were higher for patients who were diagnosed in academic centres. These results show population‐based outcomes of pCCA and highlight the importance of regional collaboration in the treatment of these patients.

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“…3,11 Finally, resection of pCCA is high-risk surgical procedure with a postoperative 90-day mortality rate between 5 and 18% in Western series, [12][13][14][15] and as such the possible benefit does not outweigh the risks in patients with advanced age, serious co-morbidity, or frailty. [16][17][18] The Mayo Clinic and several other centers in the United States and Europe are currently treating a select subgroup of patients with locally advanced pCCA with neoadjuvant chemoradiation and liver transplantation (LT). [19][20][21] In patients treated according to this protocol, a 5-year survival of 53%, slightly superior to the survival of patients after surgery for resectable disease, could be achieved.…”

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Eligibility for liver transplantation in patients with perihilar cholangiocarcinoma

Vugts

Gaspersz

Roos

et al. 2020

European Journal of Surgical Oncology

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Background. Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. Methods. Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. Results. A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3-23). Conclusion. Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed. Perihilar cholangiocarcinoma (pCCA) is the most common malignancy of the biliary tract and arises from biliary epithelial cells at the liver hilum. 1,2 The annual incidence in Western countries is about 1-2 per 100,000. 3 The standard curative option for patients with pCCA is a radical surgical resection which is associated with a median overall survival (OS) of 40 months after resection and a 5-year survival of 30-50%. 4,5 The majority of patients with pCCA ([ 80%), however, are considered unresectable at the time of presentation. 6,7 The median survival of patients with unresectable disease is only 6 months, which can be prolonged to a median of 12 months by palliative chemotherapy including gemcitabine and cisplatinum. 6-8 Bas Groot Koerkamp and Stefan Buettner have contributed equally to this work.

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

Abstract: Surgical success was achieved in only 30% of patients with PHC undergoing exploratory laparotomy and could be predicted by age, cholangitis, hepatic artery involvement, lymph node metastases, and Blumgart stage.

Cited by 19 publications

References 30 publications

Superiority of clinical American Joint Committee on Cancer T classification for perihilar cholangiocarcinoma

Superiority of clinical American Joint Committee on Cancer T classification for perihilar cholangiocarcinoma

Nationwide treatment and outcomes of perihilar cholangiocarcinoma

Eligibility for liver transplantation in patients with perihilar cholangiocarcinoma

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