TY - JOUR
T1 - Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma
T2 - Results from a Western Multicenter Collaborative Group
AU - Ruzzenente, Andrea
AU - Bagante, Fabio
AU - Olthof, Pim B.
AU - Aldrighetti, Luca
AU - Alikhanov, Ruslan
AU - Cescon, Matteo
AU - Koerkamp, Bas Groot
AU - Jarnagin, William R.
AU - Nadalin, Silvio
AU - Pratschke, Johann
AU - Schmelzle, Moritz
AU - Sparrelid, Ernesto
AU - Lang, Hauke
AU - Iacono, Calogero
AU - van Gulik, Thomas M.
AU - Guglielmi, Alfredo
AU - Andreou, A.
AU - Bartsch, F.
AU - Benzing, C.
AU - Buettner, S.
AU - Campagnaro, T.
AU - Capobianco, I.
AU - Charco, R.
AU - de Reuver, P.
AU - de Savornin Lohman, E.
AU - Dejong, C. H.C.
AU - Efanov, M.
AU - Erdmann, J. I.
AU - Franken, L. C.
AU - Giovinazzo, G.
AU - Giglio, M. C.
AU - Gomez-Gavara, C.
AU - Heid, F.
AU - IJzermans, J. N.M.
AU - Isaac, J.
AU - Jansson, H.
AU - Ligthart, M. A.P.
AU - Maithel, S. K.
AU - Malagò, M.
AU - Malik, H. Z.
AU - Muiesan, P.
AU - Damink, S. W.M.Olde
AU - Quinn, L. M.
AU - Ratti, F.
AU - Ravaioli, M.
AU - Rolinger, J.
AU - Schadde, E.
AU - Serenari, M.
AU - Troisi, R.
AU - van Laarhoven, S.
AU - Perihilar Cholangiocarcinoma Collaboration Group
N1 - Funding Information:
Perihilar Cholangiocarcinoma Collaboration Group: Andreou A (King's College London, London, UK), Bartsch F (University Hospital of Mainz, Mainz, Germany), Benzing C (Charité University Hospital, Berlin, Germany), Buettner S (Erasmus Medical Center, Rotterdam, the Netherlands), Campagnaro T (University of Verona, Verona, Italy), Capobianco I (University Hospital Tübingen, Tübingen,Germany), Charco R (Universidad Autónoma de Barcelona, Barcelona, España), de Reuver P (Radboud University Medical Center, Nijmegen, The Netherlands), de Savornin Lohman E (Radboudumc, Nijmegen, The Netherlands), Dejong CHC (Maastricht University, Maastricht, The Netherlands), Efanov M (Moscow Clinical Scientific Center, Moscow, Russia), Erdmann JI (University Medical Center Groningen, Groningen, the Netherlands), Franken LC (University of Amsterdam, Amsterdam, The Netherlands), Giovinazzo G (University Hospital Aintree, Liverpool, UK), Giglio MC (Federico II University of Naples, Naples, Italy), Gomez-Gavara C (Universidad Autónoma de Barcelona, Barcelona, España), Heid F (University Hospital of Mainz, Mainz, Germany), IJzermans JNM (University Medical Center Rotterdam, Rotterdam, The Netherlands), Isaac J (Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom), Jansson H (Karolinska Institutet, Stockholm, Sweden), Ligthart MAP (Rijnstate Hospital, Arnhem, The Netherlands), Maithel SK (Emory University, Atlanta, GA, USA), Malagò M (University College London, Royal Free Hospitals, London, UK), Malik HZ (Aintree University Hospital, Liverpool, UK), Muiesan P (Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom), Olde Damink SWM (Maastricht University Medical Center, Maastricht, The Netherlands), Quinn LM (University of Liverpool, Liverpool, UK), Ratti F (Ospedale San Raffaele-IRCCS, Milan, Italy), Ravaioli M (Alma Mater Studiorum - University of Bologna, Bologna, Italy), Rolinger J (University Hospital Tuebingen, Tuebingen, Germany), Schadde E (University of Zurich, Zurich, Switzerland), Serenari M (Alma Mater Studiorum - University of Bologna, Bologna, Italy), Troisi R (Federico II University of Naples, Naples, Italy), van Laarhoven S (University College London, Royal Free Hospitals, London, UK), van Vugt JLA (University Medical Center Rotterdam, Rotterdam, The Netherlands).
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background: Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. Methods: Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. Results: Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p =0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). Conclusions: In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.
AB - Background: Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. Methods: Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. Results: Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p =0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). Conclusions: In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.
U2 - 10.1245/s10434-021-09905-z
DO - 10.1245/s10434-021-09905-z
M3 - Article
SN - 1068-9265
VL - 28
SP - 7719
EP - 7729
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 12
ER -