A team from New York, USA, analyzed resectability and survival in patients with hilar cholangiocarcinoma. They did this according to a proposed preoperative staging scheme that fully integrated local, tumor-related factors.
Demographics, results of imaging studies, surgical findings, pathology, and survival were analyzed prospectively in 225 consecutive patients, between 1991 and 2000.
Using data from imaging studies, all patients were placed into one of three stages. These were based on the extent of ductal involvement by tumor, the presence or absence of portal vein compromise, and the presence or absence of hepatic lobar atrophy.
Of the patients, 77% were seen and treated within the last 6 years.
A total of 65 patients had unresectable disease; 160 patients underwent exploration with curative intent.
|Staging system based upon:|
- Ductal involvement by tumor
- Portal vein compromise
- Hepatic lobar atrophy
|Annals of Surgery|
Some 80 patients underwent resection: 62 (78%) had a concomitant hepatic resection and 62 (78%) had an R0 resection (negative histologic margins).
The researchers found that negative histologic margins, concomitant partial hepatectomy, and well-differentiated tumor histology were associated with improved outcome after all resections.
However, in patients who underwent an R0 resection, concomitant partial hepatectomy was the only independent predictor of long-term survival.
Of the 9 actual 5-year survivors (of 30 at risk), all had a concomitant hepatic resection, and none had tumor-involved margins. Of these 9 patients, 3 remained free of disease at a median follow-up of 88 months.
The rates of complications and death after resection were 64% and 10%, respectively.
In the 219 patients whose disease could be staged, the proposed system predicted resectability and the likelihood of an R0 resection. Furthermore, it correlated with metastatic disease and survival.
Dr William R. Jarnagin, of the Memorial Sloan-Kettering Cancer Center, New York, said on behalf of his colleagues, "By taking full account of local tumor extent, the proposed staging system for hilar cholangiocarcinoma accurately predicts resectability, the likelihood of metastatic disease, and survival."
"Complete resection remains the only therapy that offers the possibility of long-term survival. Hepatic resection is a critical component of the surgical approach," he concluded.