The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: A multi-institutional analysis of 305 cases

Mechteld C. De Jong, Hugo Marques, Bryan M. Clary, Todd W. Bauer, J. Wallis Marsh, Dario Ribero, Pietro Majno, Ioannis Hatzaras, Dustin M. Walters, Andrew S. Barbas, Raquel Mega, Richard D. Schulick, Michael A. Choti, David A. Geller, Eduardo Barroso, Gilles Mentha, Lorenzo Capussotti, Timothy M. Pawlik

Research output: Contribution to journalArticle

112 Scopus citations

Abstract

BACKGROUND. Surgical strategy for hilar cholangiocarcinoma often includes hepatectomy, but the role of portal vein resection (PVR) remains controversial. In this study, the authors sought to identify factors associated with outcome after surgical management of hilar cholangiocarcinoma and examined the impact of PVR on survival. METHODS: Three hundred five patients who underwent curative-intent surgery for hilar cholangiocarcinoma between 1984 and 2010 were identified from an international, multi-institutional database. Clinicopathologic data were evaluated using univariate and multivariate analyses. RESULTS: Most patients had hilar cholangiocarcinoma with tumors classified as T3/T4 (51.1%) and Bismuth-Corlette type II/III (60.9%). Resection involved extrahepatic bile duct resection (EHBR) alone (26.6%); or hepatectomy and EHBR without PVR (56.7%); or combined hepatectomy, EHBR, and PVR (16.7%). Negative resection (R0) margin status was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 64.2%; with PVR, 66.7%) versus EHBR alone (54.3%; P <.001). The median number of lymph nodes assessed was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 6 lymph nodes; with PVR, 4 lymph nodes) versus EHBR alone (2 lymph nodes; P <.001). The 90-day mortality rate was lower for patients who underwent EHBR alone (1.2%) compared with the rate for patients who underwent hepatectomy plus EHBR (without PVR, 10.6%, with PVR, 17.6%; P <.001). The overall 5-year survival rate was 20.2%. Factors that were associated with an adverse prognosis included lymph node metastasis (hazard ratio [HR], 1.79; P =.002) and R1 margin status (HR, 1.81; P <.001). Microscopic vascular invasion did not influence survival (HR, 1.23; P =.19). Among the patients who underwent hepatectomy plus EHBR, PVR was not associated with a worse long-Term outcome (P =.76). CONCLUSIONS: EHBR alone was associated with a greater risk of positive surgical margins and worse lymph node clearance. The current results indicated that hepatectomy should be considered the standard treatment for hilar cholangiocarcinoma, and PVR should be undertaken when necessary to extirpate all disease. Combined hepatectomy, EHBR, and PVR can offer long-Term survival in some patients with advanced hilar cholangiocarcinoma.

Original languageEnglish (US)
Pages (from-to)4737-4747
Number of pages11
JournalCancer
Volume118
Issue number19
DOIs
StatePublished - Oct 1 2012

Keywords

  • cholangiocarcinoma
  • hilar
  • outcome
  • portal vein

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: A multi-institutional analysis of 305 cases'. Together they form a unique fingerprint.

  • Cite this

    De Jong, M. C., Marques, H., Clary, B. M., Bauer, T. W., Marsh, J. W., Ribero, D., Majno, P., Hatzaras, I., Walters, D. M., Barbas, A. S., Mega, R., Schulick, R. D., Choti, M. A., Geller, D. A., Barroso, E., Mentha, G., Capussotti, L., & Pawlik, T. M. (2012). The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: A multi-institutional analysis of 305 cases. Cancer, 118(19), 4737-4747. https://doi.org/10.1002/cncr.27492