The prognostic role of tumor-associated unilateral portal vein occlusion in perihilar cholangiocarcinoma

J. Bednarsch, Z. Czigany, L.R. Heij, T. Luedde, G. Wiltberger, M. den Dulk, P. Bruners, S.A. Lang, T.F. Ulmer, U.P. Neumann*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Web of Science)

Abstract

Background: While a certain degree of tumor infiltration of the portal vein is common in patients with perihilar cholangiocarcinoma (pCCA) scheduled for surgery, complete tumor-associated portal vein occlusion (PVO) is less frequently observed. Here, we analyzed the impact of PVO on perioperative and oncological outcomes in pCCA patients. Methods: Between 2010 and 2019, 127 patients with pCCA underwent surgery in curative intent at our department of which 17.3% (22/127) presented with PVO. Extensive group comparisons were conducted and the association of cancer-specific (CSS) and disease-free survival (DFS) with PVO and other clinico-pathological characteristics were assessed using Cox regression models. Results: Patients without PVO showed a median CSS of 65 months (3-year-CSS = 64%, 5-year-CSS = 53%) compared to 31 months (3-year-CSS = 43%, 5-year-CSS = 17%) in patients with PVO (p = 0.025 log rank). Patients with PVO did also display significant perioperative mortality (22.7%, 5/22) compared to patients without PVO (14.3%, 15/105, p = 0.323). Further, PVO (CSS: HR = 5.25, p = 0.001; DFS: HR = 5.53, p = 0.001) was identified as independent predictors of oncological outcome. Conclusions: PVO has been identified as an important prognostic marker playing a role in inferior oncological outcome in patients with pCCA. As PVO is also associated with notable perioperative mortality, surgical therapy should be considered carefully in pCCA patients.
Original languageEnglish
Pages (from-to)1565-1577
Number of pages13
JournalHPB
Volume23
Issue number10
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • POSITRON-EMISSION-TOMOGRAPHY
  • CURATIVE-INTENT RESECTION
  • HILAR CHOLANGIOCARCINOMA
  • INTRAHEPATIC CHOLANGIOCARCINOMA
  • VASCULAR RESECTION
  • SURGICAL-TREATMENT
  • TISSUE FACTOR
  • CANCER
  • LIVER
  • MANAGEMENT

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