Impact of Combined Vascular Resection and Reconstruction in Patients with Advanced Perihilar Cholangiocarcinoma.
Perihilar cholangiocarcinoma, Vascular resection and reconstruction, Carcinoembryonic antigen
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
23
01
2021
accepted:
29
03
2021
pubmed:
23
4
2021
medline:
30
12
2021
entrez:
22
4
2021
Statut:
ppublish
Résumé
Perihilar cholangiocarcinoma often involves the adjacent vasculature, including the portal vein and hepatic artery. Combined vascular resection and reconstruction of the portal vein is more common than vascular resection and reconstruction of the hepatic artery. Herein, we aimed to elucidate the long-term outcomes in patients who underwent vascular resection and reconstruction for perihilar cholangiocarcinoma. Between January 2004 and December 2020, 106 patients with perihilar cholangiocarcinoma were grouped into the no resection (n = 58), resection-portal vein (n = 31), and resection-hepatic artery with or without that of portal vein (n = 17) groups. There were no significant differences in morbidity and mortality between the three groups. The resection-portal vein and resection-hepatic artery groups had a significantly higher number of advanced tumors than the no resection group, but no significant differences were detected in the rates of lymph node metastasis and R0 resection between the three groups. The 5-year disease-specific survival in the resection-portal vein (37.6%) and resection-hepatic artery (26.9%) groups were poorer than that in the no resection group (47.8%), although the former groups had a significantly better prognosis than the latter group (7.0%). Multivariate analysis identified high preoperative carcinoembryonic antigen level (>5.7 ng/mL), intrahepatic metastasis, and non-R0 resection as independent poor prognostic factors. Although the perioperative course in the resection-portal vein and hepatic artery groups was similar to that in the no resection group, the long-term prognoses were poor in the resection-portal vein and hepatic artery groups. Pre- and postoperative multidisciplinary therapy is required for patients with vascular resection and reconstruction.
Sections du résumé
BACKGROUND
Perihilar cholangiocarcinoma often involves the adjacent vasculature, including the portal vein and hepatic artery. Combined vascular resection and reconstruction of the portal vein is more common than vascular resection and reconstruction of the hepatic artery. Herein, we aimed to elucidate the long-term outcomes in patients who underwent vascular resection and reconstruction for perihilar cholangiocarcinoma.
METHODS
Between January 2004 and December 2020, 106 patients with perihilar cholangiocarcinoma were grouped into the no resection (n = 58), resection-portal vein (n = 31), and resection-hepatic artery with or without that of portal vein (n = 17) groups.
RESULTS
There were no significant differences in morbidity and mortality between the three groups. The resection-portal vein and resection-hepatic artery groups had a significantly higher number of advanced tumors than the no resection group, but no significant differences were detected in the rates of lymph node metastasis and R0 resection between the three groups. The 5-year disease-specific survival in the resection-portal vein (37.6%) and resection-hepatic artery (26.9%) groups were poorer than that in the no resection group (47.8%), although the former groups had a significantly better prognosis than the latter group (7.0%). Multivariate analysis identified high preoperative carcinoembryonic antigen level (>5.7 ng/mL), intrahepatic metastasis, and non-R0 resection as independent poor prognostic factors.
CONCLUSION
Although the perioperative course in the resection-portal vein and hepatic artery groups was similar to that in the no resection group, the long-term prognoses were poor in the resection-portal vein and hepatic artery groups. Pre- and postoperative multidisciplinary therapy is required for patients with vascular resection and reconstruction.
Identifiants
pubmed: 33884578
doi: 10.1007/s11605-021-05004-2
pii: 10.1007/s11605-021-05004-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3108-3118Informations de copyright
© 2021. The Society for Surgery of the Alimentary Tract.
Références
Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 2013;258:129-140.
doi: 10.1097/SLA.0b013e3182708b57
Kawarada Y, Das BC, Taoka H. Anatomy of the hepatic hilar area: the plate system. J Hepatobiliary Pancreat Surg. 2000;7:580-6.
doi: 10.1007/s005340070007
Abbas S, Sandroussi C. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma. HPB (Oxford) 2013;15:492-503.
doi: 10.1111/j.1477-2574.2012.00616.x
Bai T, Chen J, Xie ZB, Ma L, Liu JJ, Zhu SL, Wu FX, Li LQ. Combined portal vein resection for hilar cholangiocarcinoma. Int J Clin Exp Med 2015;8:21044-21052.
pmcid: 4723880
Wu XS, Dong P, Gu J, Li ML, Wu WG, Lu JH, Mu JS, Ding QC, Zhang L, Ding Q, Weng H, Liu YB. Combined portal vein resection for hilar cholangiocarcinoma: a meta-analysis of comparative studies. J Gastrointest Surg 2013;17:1107-1115.
doi: 10.1007/s11605-013-2202-9
Chen W, Ke K, Chen YL. Combined portal vein resection in the treatment of hilar cholangiocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol 2014;40:489-495.
doi: 10.1016/j.ejso.2014.02.231
Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, Yoshidome H, Yoshitomi H, Furukawa K, Nozawa S. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 2007;141:581-588.
doi: 10.1016/j.surg.2006.09.016
Kuriyama N, Usui M, Gyoten K, Hayasaki A, Fujii T, Iizawa Y, Kato H, Murata Y, Tanemura A, Kishiwada M, Sakurai H, Mizno S, Isaji S. Neoadjuvant chemotherapy followed by curative-intent surgery for perihilar cholangiocarcinoma based on its anatomical resectability classification and lymph node status. BMC Cancer 2020;20:405.
doi: 10.1186/s12885-020-06895-1
Kuriyama N, Isaji S, Tanemura A, Iizawa Y, Kato H, Murata Y, Azumi Y, Kishiwada M, Mizuno S, Usui M, Sakurai H. Transhepatic hilar approach for perihilar cholangiocarcinoma: significance of early judgment of resectability and safe vascular reconstruction. J Gastrointest Surg 2017;21:590-599.
doi: 10.1007/s11605-016-3332-7
Ikeyama T, Nagino M, Oda K, Ebata T, Nishio H, Nimura Y. Surgical approach to bismuth Type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg 2007;246:1052-1057.
doi: 10.1097/SLA.0b013e318142d97e
Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999;230:808-818.
doi: 10.1097/00000658-199912000-00010
Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, Makuuchi M. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 2003;238:73-83.
pmcid: 1422671
Sumiyoshi T, Shima Y, Okabayashi T, Kozuki A, Hata Y, Noda Y, Kouno M, Miyagawa K, Tokorodani R, Saisaka Y, Tokumaru T, Nakamura T, Morita S. Liver function assessment using 99mTc-GSA single-photon emission computed tomography (SPECT)/CT fusion imaging in hilar bile duct cancer: A retrospective study. Surgery 2016;160:118-126.
doi: 10.1016/j.surg.2016.02.009
Yokoyama Y, Nishio H, Ebata T, Igami T, Sugawara G, Nagino M. Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br J Surg 2010;97:1260-1268.
doi: 10.1002/bjs.7084
Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otsuka M, Kato A, Hideyuki Y, Nozawa S, Furukawa K, Mituhashi N, Takeuchi D, Suda K, Takano S. Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases. Am J Surg 2008;196:125-129.
doi: 10.1016/j.amjsurg.2007.04.020
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196.
doi: 10.1097/SLA.0b013e3181b13ca2
Nagino M. Perihilar cholangiocarcinoma: a surgeon’s viewpoint on current topics. J Gastroenterol 2012;47:1165-1176.
doi: 10.1007/s00535-012-0628-6
Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, Nishikimi N, Kamei Y. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 2010;252:115-23.
doi: 10.1097/SLA.0b013e3181e463a7
Matsuyama R, Mori R, Ota Y, Homma Y, Kumamoto T, Takeda K, Norioka D, Maegawa J, Endo I. Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol 2016;23:475-484.
doi: 10.1245/s10434-016-5381-2
Hu HJ, Jin YW, Zhou RX, Shrestha A, Ma WJ, Yang Q, Wang JK, Liu F, Cheng NS, Li FY. Hepatic artery resection for bismuth type III and IV hilar cholangiocarcinoma: is reconstruction always required? J Gastrointest Surg 2018;22:1204-1212.
doi: 10.1007/s11605-018-3711-3
Mizuno T, Ebata T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, Watanabe N, Kamei Y, Nagino M. Combined vascular resection for locally advanced perihilar cholangiocarcinoma. Ann Surg 2020. https://doi.org/10.1097/SLA.0000000000004322 .
Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, Kim KH, Ahn CS, Kim MH, Lee SK, Sung KB, Ko GY. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asian experience. J Hepatobiliary Pancreat Sci 2010;17:476-489.
doi: 10.1007/s00534-009-0204-5
Hu HJ, Mao H, Shrestha A, Tan YQ, Ma WJ, Yang Q, Wang JK, Cheng NS, Li FY. Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: a single-institution experience in China. World J Gastroenterol 2016;22:2601-2610.
doi: 10.3748/wjg.v22.i8.2601
Higuchi R, Yazawa T, Uemura S, Izumo W, Ota T, Kiyohara K, Furukawa T, Egawa H, Yamamoto M. Surgical outcomes for perihilar cholangiocarcinoma with vascular invasion. J Gastrointest Surg 2019;23:1443-1453.
doi: 10.1007/s11605-018-3948-x
Loosen SH, Roderburg C, Kauertz KL, Koch A, Vucur M, Schneider AT, Binnebösel M, Ulmer TF, Lurje G, Schoening W, Tacke F, Trautwein C, Longerich T, Dejong CH, Neumann UP, Luedde T. CEA but not CA19-9 is an independent prognostic factor in patients undergoing resection of cholangiocarcinoma. Sci Rep 2017;7:16975.
doi: 10.1038/s41598-017-17175-7
Ito T, Kuriyama N, Kozuka Y, Komatsubara H, Ichikawa K, Noguchi D, Hayasaki A, Fujii T, Iizawa Y, Kato H, Tanemura A, Murata Y, Kishiwada M, Mizuno S, Usui M, Sakurai H, Isaji S. High tumor budding is a strong predictor of poor prognosis in the resected perihilar cholangiocarcinoma patients regardless of neoadjuvant therapy, showing survival similar to those without resection. BMC Cancer 2020;12;20:209.
doi: 10.1186/s12885-020-6695-9