Surgery for extrahepatic cholangiocarcinoma: predictors of survival

Abstract

The incidence of extrahepatic cholangiocarcinoma is increasing worldwide and is often in an advanced stage at diagnosis and difficult to treat. The TNM (tumor node metastasis) cancer staging system predicts survival on the basis of tumor histopathology and the presence of distant metastases. However, numerous prognostic factors have been described that are not included in the TNM system. This review focuses on the prognostic significance of clinical, surgical, and histopathological factors as reported in the literature. Overall, the most important independent prognostic factors for long-term survival are negative surgical margins, lymph node status, and differentiation grade of the tumor. Further improvement of staging systems and identification of prognostic factors are crucial if we are to better select patients for surgical and adjuvant therapy and, hence, increase the rate of curative resections.

Klatskin Tumour: Meticulous Preoperative Work-Up and Resection Rate

“…The resection of the first segment and of adjacent parts of segment 4 has been widely accepted as the standard procedure [30,31]. Resection of the hilar bile duct bifurcation appears to be obsolete [3,5,27,32]. This is supported by our analysis.…”

Impact of portal vein resection on oncologic long-term outcome in patients with hilar cholangiocarcinoma

“…3,5,6 An important factor for long-term survival in patients with HCA is to achieve negative resection margins. 28 Better patient selection and improved preoperative work-up of candidates for resection improved the long-term outcomes. 29 New techniques such as intravascular ultrasound of the portal vein might add additional information on the status of potential vascular invasion in the future.…”

Outcome of surgical resection in Klatskin tumors

“…Published 5-year survival rates range from 25% to 40% in recent series, and, even, it has been reported that many clinical and histological factors have a positive impact on long-term outcome, including negative histologic margin status [99,100] , concomitant hepatic resection [30] , absence of nodal involvement [14,23,48,101] , low TNM status [36] , welldifferentiated tumor grade [68] , papillary tumor morphology [36,44,80] , and lack of perineural invasion [23] . Complete resection with negative histologic margins is the only modifiable factor and, for that reason, the primary aim of surgical therapy.…”