Our Rationale of Initiating Neoadjuvant Chemotherapy for Hilar Cholangiocarcinoma: A Proposal of Criteria for “Borderline Resectable” in the Field of Surgery for Hilar Cholangiocarcinoma

Matsuyama, Ryusei; Morioka, Daisuke; Mori, Rintaro; Yabushita, Yasuhiro; Hiratani, Seigo; Ota, Yoshihide; Kumamoto, Takafumi; Endo, Itaru

doi:10.1007/s00268-018-04883-y

Cited by 16 publications

(7 citation statements)

References 61 publications

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“…Whereas, compared with patients underwent R0 resection only, survival of patients in R0 resection combined portal vein resection was worse, even similar to R1 resection group (24). Furthermore, cumulative survival of patients with both lymph node metastasis and vascular invasion was not signi cantly differed to the patients with unresectable HCCA (27). Low differentiation and lymph node metastasis as tumor features have been widely established (20).…”

Section: Discussionmentioning

confidence: 87%

A model predicting postoperative survival less than the natural lifespan of hilar cholangiocarcinoma: a multicenter study evaluating surgery necessity.

Yin

et al. 2023

Preprint

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Background For patients suffering from hilar cholangiocarcinoma (HCCA), it would be no sense if radical surgery didn’t result in better survival than natural lifespan. Therefore, establishing a model predicting postoperative survival less than natural lifespan may assist in surgery decision-making. Methods HCCA patients receiving radical surgery from three centers were enrolled retrospectively. Twelve months was designated the natural lifespan of HCCA, and patients were divided into long-term survival (LTS) and short-term survival (STS) groups by this cutoff value. A nomogram was established from a randomly selected training cohort comprised of 70% of patients and verified on the validation cohort comprised of the remaining 30%. The model was internally validated using 5-fold cross-validation. Decision curve analysis (DCA) and calibration curve were also used to assess the model. In-hospital costs of both groups were compared. Results Out of 245 patients, 67 (27%) had STS, with a mean survival time of 5.67 months, while 178 (73%) had LTS, with a mean survival time of 33.03 months. Among the STS group, 17 died of complications, and the others died of recurrence. Multivariable logistic regression revealed that risk factors for STS were age (OR: 1.06, 95% CI: 1.00-1.11), malnutrition (OR: 3.01, 95% CI: 1.12–8.07), CA125 (OR: 1.01, 95% CI: 1.00-1.02), vascular invasion (OR: 3.50, 95% CI: 1.33–9.21), poor differentiation (OR: 8.51, 95% CI: 2.38–30.44) and lymph node metastasis (OR: 5.04, 95% CI: 1.73–14.66). The C-index of nomogram was 0.834. DCA convinced the power of our model. The in-hospital cost of the STS group was higher than that of the LTS group (mean, 169250.8 and 138118.0, respectively, P = 0.006). Conclusions A model predicting poor prognosis could avoid unnecessary surgery and provide postoperative treatment references.

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Section: Discussionmentioning

confidence: 87%

A model predicting postoperative survival less than the natural lifespan of hilar cholangiocarcinoma: a multicenter study evaluating surgery necessity.

Yin

et al. 2023

Preprint

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“…There were significantly more patients with neoadjuvant chemo-radiation therapy or portal vein embolization in the LPG (Table 1). 2,11 However, severe complications, operation time, amount of bleeding during operation, and length of hospital stay were significantly reduced in the LPG.…”

Section: Discussionmentioning

confidence: 98%

Surgical outcomes of perihilar cholangiocarcinoma based on the learning curve of a single surgeon at a tertiary academic hospital: A retrospective study

Park

Han

Choi

et al. 2021

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Although it is difficult to master the surgical learning curve for treatment of perihilar cholangiocarcinoma (HCCA), there have been no studies on surgical outcomes between a novice and an experienced surgeon. Thus, the current study attempted to evaluate surgical outcomes from a single surgeon based on learning curve for surgical treatment of HCCA. Methods: From January 2008 to December 2016, a single surgeon performed surgical treatment for 108 patients with HCCA at Severance Hospital, Seoul, Korea. Among them, 101 patients with curative surgical resection were included in this study. The learning curve was assessed by a moving average graph and CUSUM method using operation time. Surgical outcomes between the early period group (EPG) and the late period group (LPG) were compared according to learning curve. Results: Operation time (603.17±117.59 and 432.03±91.77 minutes; p＜0.001), amount of bleeding during operation (1127.86±689.54 and 613.05±548.31 ml; p＜0.001), and severe complication rates (47.6% and 27.1%, p=0.034) were significantly smaller in the LPG. There was no significant difference in R0 resection rate (85.7% and 76.3%; p=0.241) as well as long-term survival rate. Conclusions: In this study, operation time, amount of bleeding during operation, length of hospital stay, and severe complication rate were improved after stabilization of the learning curve. However, R0 resection rate and survival outcomes were not significantly influenced by the learning curve for surgical treatment of HCCA.

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“…They indicated that the control of LN metastasis was very difficult by surgical treatment alone and that establishment of effective AC was urgently needed. The other study reported that patients with both regional LN metastasis and vascular invasion were candidate for initiating NAC to obtain better outcomes [32]. Therefore, our present study enrolled the patients with clinically obvious LN metastasis, BR, and LA for NAC using GS therapy followed by curative-intent surgery.…”

Section: Discussionmentioning

confidence: 99%

“…They defined that BR perihilar cholangiocarcinoma had a chance of curative resection but an unclear longitudinal tumor extent. In 2017, Matsuyama et al secondly reported that patients with both regional LN metastasis and vascular invasion were oncologically defined as BR because such patients had dismal outcome [32]. Our new resectability classification is based on PV, HA and biliary involvements according to surgical points of view, and consists of the three categories (R, BR, and LA).…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy followed by curative-intent surgery for perihilar cholangiocarcinoma based on its anatomical resectability classification and lymph node status

et al. 2020

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Background: The prognosis of patients with perihilar cholangiocarcinoma have been unsatisfactory. We established new anatomical resectability classification for patients with localized perihilar cholangiocarcinoma and performed neoadjuvant chemotherapy followed by curative-intent surgery based on its resectability classification and lymph node status to improve prognosis. This study aimed to clarify the long-term outcomes and validation of our strategy. Methods: Between September 2010 and August 2018, 72 consecutive patients with perihilar cholangiocarcinoma were classified into three groups: Resectable (R = 29), Borderline resectable (BR = 23), and Locally advanced (LA = 20), based on the two factors of tumor vascular and biliary extension. R with clinically lymph node metastasis, BR, and LA patients received neoadjuvant chemotherapy using gemcitabine plus S-1. Results: Forty-seven patients (65.3%) received neoadjuvant chemotherapy: R in 8, BR in 21, and 18 in LA, respectively. Fifty-nine patients (68.1%) underwent curative-intent surgery: R in 26, BR in 17, and LA in 6. Five-year disease-specific survival was 31.5% (median survival time: 33.0 months): 50.3% (not reached) in R, 30.0% (31.4 months) in BR, and 16.5% (22.5 months) in LA, which were relatively stratified. Among 49 patients with resection, disease-specific survival was 43.8% (57.0 months): 57.6% (not reached) in R, 41.0% (52.4 months) in BR, and 0% (49.4 months) in LA, which were significantly good prognosis compared to 23 patients without resection (17.2 months). Multivariate analysis identified preoperative high carcinoembryonic antigen levels (more than 8.5 ng/ml) and pT4 as independent poor prognostic factor of patients with resection. Conclusion: Neoadjuvant chemotherapy based on resectability classification and lymph node status was feasible, and was considered efficacious in selected patients.

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Our Rationale of Initiating Neoadjuvant Chemotherapy for Hilar Cholangiocarcinoma: A Proposal of Criteria for “Borderline Resectable” in the Field of Surgery for Hilar Cholangiocarcinoma

Cited by 16 publications

References 61 publications

A model predicting postoperative survival less than the natural lifespan of hilar cholangiocarcinoma: a multicenter study evaluating surgery necessity.

A model predicting postoperative survival less than the natural lifespan of hilar cholangiocarcinoma: a multicenter study evaluating surgery necessity.

Surgical outcomes of perihilar cholangiocarcinoma based on the learning curve of a single surgeon at a tertiary academic hospital: A retrospective study

Neoadjuvant chemotherapy followed by curative-intent surgery for perihilar cholangiocarcinoma based on its anatomical resectability classification and lymph node status

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