Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach

Zervos, Emmanuel E.; Osborne, Dana; Goldin, Steven B.; Villadolid, Desiree; Thometz, Donald; Durkin, Alan J.; Carey, Larry C.; Rosemurgy, Alexander S.

doi:10.1016/j.amjsurg.2005.07.025

Cited by 52 publications

(34 citation statements)

References 17 publications

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“…[8][9][10][11] However, despite the use of aggressive surgery, the 5-year survival rate of hilar cholangiocarcinoma has remained 20% to 40% although the mortality and morbidity rate have gradually decreased. 2,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Therefore, adjuvant therapeutic modalities including chemotherapy or radiotherapy are needed for long-term survival. Although there is no established adjuvant therapy for cholangiocarcinoma at present, new anticancer drugs, including gemcitabine, 25 oxaliplatin, 26 capecitabine, 27 and S-1, 28 have recently been reported as useful for patients with unresectable biliary carcinomas.…”

Section: Introductionmentioning

confidence: 98%

Gemcitabine-Based Adjuvant Chemotherapy Improves Survival After Aggressive Surgery for Hilar Cholangiocarcinoma

Murakami

Uemura

Sudo

et al. 2009

Journal of Gastrointestinal Surgery

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Section: Introductionmentioning

confidence: 98%

Gemcitabine-Based Adjuvant Chemotherapy Improves Survival After Aggressive Surgery for Hilar Cholangiocarcinoma

Murakami

Uemura

Sudo

et al. 2009

Journal of Gastrointestinal Surgery

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“…During the last decade, major progress has been made in the surgical techniques. The frequency of resections carried out (even in extended CCA, stages III and IVA) increased from 50% to 80%, and R0 resections are obtained in 75% to 90% when a partial hepatectomy is carried out [73,76,77]. The perioperative mortality was initially 8-12% for these more extensive resections but is now decreasing to 4-5% [73].…”

Section: Resectionmentioning

confidence: 96%

Incidence, Diagnosis, and Therapy of Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis

Fevery¹,

et al. 2007

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Primary sclerosing cholangitis (PSC) can lead to the development of cholangiocarcinoma (CCA). The tumor may present as an intrahepatic focal cholangiocellular carcinoma but more often as a ductal infiltrating desmoplastic lesion. CCA is found synchronously with the diagnosis of PSC in 20-30% and within 1 year in 50%. During later follow-up, the yearly developmental rate of CCA is 0.5-1.5%. Most patients with PSC and CCA do not yet have cirrhosis but present with a severe stenosis at the hilum of the liver. This type of tumor is difficult to diagnose by imaging techniques.(18)F-FDG-PET scanning and CEA or CA 19-9 are not early diagnostic tools. Regular MRI, multislice CT, and repeated endoscopically obtained brush cytology of stenotic lesions are recommended. The recent use of more extensive surgical resection techniques in patients with CCA results in 5-year survival rates of > or =50%. If tumors are small or incidental findings, liver transplantation leads to a 3- to 5-year survival rate of 35%. Pretransplant radiotherapy with 5-FU chemosensitization followed by endoscopic brachytherapy with iridium-192 seems to greatly improve the outcome of transplantation. Treatment with ursodeoxycholic acid may prevent development of CCA.

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“…There are currently 3 main staging systems utilized for patients with hilar cholangiocarcinomas: AJCC, BismuthCorlette, and Blumg ar t [9] . The AJCC tumor-nodemetastasis (TNM) staging system is only applicable to patients who have undergone resection [4] .…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that the AJCC or Bismuth-Corlette systems has been misused by a www.wjgnet.com generation of medical oncologists and surgeons who have used staging systems based on postoperative evaluation of the tumor to guide the preoperative, intraoperative, and even postoperative management [9,10] .…”

Section: Introductionmentioning

confidence: 99%

“…Currently, the modified Bismuth-Corlette system and American Joint Committee on Cancer (AJCC) systems are still commonly used in evaluation of hilar cholangiocarcinoma in China, but both of them are failure to identify patients who are operative candidates or to provide prognostic information [5,8,9] . It is possible that the AJCC or Bismuth-Corlette systems has been misused by a www.wjgnet.com generation of medical oncologists and surgeons who have used staging systems based on postoperative evaluation of the tumor to guide the preoperative, intraoperative, and even postoperative management [9,10] .…”

Section: Introductionmentioning

confidence: 99%

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Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

Chen

Li²,

Zhou³

et al. 2007

WJG

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AIM:To investigate the clinical value of T-staging s y s t e m i n t h e p re o p e ra t i ve a s s e s s m e n t o f h i l a r cholangiocarcinoma. METHODS:From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging. RESULTS:The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage (P < 0.05). The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly (P < 0.001). Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection (28 mo vs 18 mo; P < 0.05). The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy (91.4% vs 68%; P < 0.05 ). And it was also higher in detecting port vein involvement (90% vs 54.5%; P < 0.05). CONCLUSION:The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of longterm survival. MRCP/MRA coupled with color Doppler Ultrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.

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Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach

Cited by 52 publications

References 17 publications

Gemcitabine-Based Adjuvant Chemotherapy Improves Survival After Aggressive Surgery for Hilar Cholangiocarcinoma

Gemcitabine-Based Adjuvant Chemotherapy Improves Survival After Aggressive Surgery for Hilar Cholangiocarcinoma

Incidence, Diagnosis, and Therapy of Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis

Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

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