Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution

Michelle L. DeOliveira, Steven C. Cunningham, John L. Cameron, Farin Kamangar, Jordan M. Winter, Keith D. Lillemoe, Michael A. Choti, Charles J. Yeo, Richard D. Schulick

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Abstract

OBJECTIVE: To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. SUMMARY BACKGROUND DATA: The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. METHODS: We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. RESULTS: Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively. CONCLUSION: R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.

Original languageEnglish (US)
Pages (from-to)755-762
Number of pages8
JournalAnnals of Surgery
Volume245
Issue number5
DOIs
StatePublished - May 2007

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Cholangiocarcinoma
Bile Duct Neoplasms
Survival
Neoplasms
Lymph Nodes
Mortality
Lymph
Survival Analysis
Histology
Multivariate Analysis
Outcome Assessment (Health Care)
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

DeOliveira, M. L., Cunningham, S. C., Cameron, J. L., Kamangar, F., Winter, J. M., Lillemoe, K. D., ... Schulick, R. D. (2007). Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution. Annals of Surgery, 245(5), 755-762. https://doi.org/10.1097/01.sla.0000251366.62632.d3

Cholangiocarcinoma : Thirty-one-year experience with 564 patients at a single institution. / DeOliveira, Michelle L.; Cunningham, Steven C.; Cameron, John L.; Kamangar, Farin; Winter, Jordan M.; Lillemoe, Keith D.; Choti, Michael A.; Yeo, Charles J.; Schulick, Richard D.

In: Annals of Surgery, Vol. 245, No. 5, 05.2007, p. 755-762.

Research output: Contribution to journalArticle

DeOliveira, ML, Cunningham, SC, Cameron, JL, Kamangar, F, Winter, JM, Lillemoe, KD, Choti, MA, Yeo, CJ & Schulick, RD 2007, 'Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution', Annals of Surgery, vol. 245, no. 5, pp. 755-762. https://doi.org/10.1097/01.sla.0000251366.62632.d3
DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD et al. Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution. Annals of Surgery. 2007 May;245(5):755-762. https://doi.org/10.1097/01.sla.0000251366.62632.d3
DeOliveira, Michelle L. ; Cunningham, Steven C. ; Cameron, John L. ; Kamangar, Farin ; Winter, Jordan M. ; Lillemoe, Keith D. ; Choti, Michael A. ; Yeo, Charles J. ; Schulick, Richard D. / Cholangiocarcinoma : Thirty-one-year experience with 564 patients at a single institution. In: Annals of Surgery. 2007 ; Vol. 245, No. 5. pp. 755-762.
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abstract = "OBJECTIVE: To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. SUMMARY BACKGROUND DATA: The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. METHODS: We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. RESULTS: Of the 564 patients, 44 (8{\%}) had intrahepatic, 281 (50{\%}) had perihilar, and 239 (42{\%}) had distal tumors. Approximately half (294, 52{\%}) were treated before 1995, while 270 (48{\%}) were treated thereafter. The perioperative mortality rate was 4{\%}. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63{\%}, 30{\%}, and 27{\%}, respectively. CONCLUSION: R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.",
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T1 - Cholangiocarcinoma

T2 - Thirty-one-year experience with 564 patients at a single institution

AU - DeOliveira, Michelle L.

AU - Cunningham, Steven C.

AU - Cameron, John L.

AU - Kamangar, Farin

AU - Winter, Jordan M.

AU - Lillemoe, Keith D.

AU - Choti, Michael A.

AU - Yeo, Charles J.

AU - Schulick, Richard D.

PY - 2007/5

Y1 - 2007/5

N2 - OBJECTIVE: To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. SUMMARY BACKGROUND DATA: The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. METHODS: We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. RESULTS: Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively. CONCLUSION: R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.

AB - OBJECTIVE: To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. SUMMARY BACKGROUND DATA: The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. METHODS: We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. RESULTS: Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively. CONCLUSION: R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.

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