Gallbladder cancer mimicking perihilar cholangiocarcinoma-considerable rate of postoperative reclassification with implications for prognosis.
Biliary tract cancer
Gallbladder cancer
Perihilar cholangiocarcinoma
Postoperative prognosis
Preoperative diagnosis
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
11 Sep 2023
11 Sep 2023
Historique:
received:
21
06
2023
accepted:
07
09
2023
medline:
13
9
2023
pubmed:
12
9
2023
entrez:
11
9
2023
Statut:
epublish
Résumé
For some patients undergoing resection under the suspicion of a perihilar cholangiocarcinoma (pCCA), postoperative diagnosis may differ from the preoperative diagnosis. While a postoperative finding of benign bile duct stricture is known to affect 3-15% of patients, less has been described about the consequences of finding other biliary tract cancers postoperatively. This study compared pre- and postoperative diagnoses, risk characteristics, and outcomes after surgery for suspected pCCA. Retrospective single-center study, Karolinska University Hospital, Stockholm, Sweden (January 2009-May 2017). The primary postoperative outcome was overall survival. Secondary outcomes were disease-free survival and postoperative complications. Survival analysis was performed by the Kaplan-Meier method. Seventy-one patients underwent resection for suspected pCCA. pCCA was confirmed in 48 patients (68%). Ten patients had benign lesions (14%), 2 (3%) were diagnosed with other types of cholangiocarcinoma (CCA, distal n = 1, intrahepatic n = 1), while 11 (15%) were diagnosed with gallbladder cancer (GBC). GBC patients were older than patients with pCCA (median age 71 versus 58 years, p = 0.015), with a large proportion of patients with a high tumor extension stage (≥ T3, 91%). Median overall survival was 20 months (95% CI 15-25 months) for patients with pCCA and 17 months (95% CI 11-23 months) for patients with GBC (p = 0.135). Patients with GBC had significantly shorter median disease-free survival (DFS), 10 months (95% CI 3-17 months) compared 17 months (95% CI 15-19 months) for patients with pCCA (p = 0.010). At a large tertiary referral center, 15% of patients resected for suspected pCCA were postoperatively diagnosed with GBC. Compared to patients with pCCA, GBC patients were older, with advanced tumors and shorter DFS. The considerable rate of re-classification stresses the need for improved preoperative staging, as these prognostic differences could have implications for treatment strategies.
Sections du résumé
BACKGROUND
BACKGROUND
For some patients undergoing resection under the suspicion of a perihilar cholangiocarcinoma (pCCA), postoperative diagnosis may differ from the preoperative diagnosis. While a postoperative finding of benign bile duct stricture is known to affect 3-15% of patients, less has been described about the consequences of finding other biliary tract cancers postoperatively. This study compared pre- and postoperative diagnoses, risk characteristics, and outcomes after surgery for suspected pCCA.
METHODS
METHODS
Retrospective single-center study, Karolinska University Hospital, Stockholm, Sweden (January 2009-May 2017). The primary postoperative outcome was overall survival. Secondary outcomes were disease-free survival and postoperative complications. Survival analysis was performed by the Kaplan-Meier method.
RESULTS
RESULTS
Seventy-one patients underwent resection for suspected pCCA. pCCA was confirmed in 48 patients (68%). Ten patients had benign lesions (14%), 2 (3%) were diagnosed with other types of cholangiocarcinoma (CCA, distal n = 1, intrahepatic n = 1), while 11 (15%) were diagnosed with gallbladder cancer (GBC). GBC patients were older than patients with pCCA (median age 71 versus 58 years, p = 0.015), with a large proportion of patients with a high tumor extension stage (≥ T3, 91%). Median overall survival was 20 months (95% CI 15-25 months) for patients with pCCA and 17 months (95% CI 11-23 months) for patients with GBC (p = 0.135). Patients with GBC had significantly shorter median disease-free survival (DFS), 10 months (95% CI 3-17 months) compared 17 months (95% CI 15-19 months) for patients with pCCA (p = 0.010).
CONCLUSIONS
CONCLUSIONS
At a large tertiary referral center, 15% of patients resected for suspected pCCA were postoperatively diagnosed with GBC. Compared to patients with pCCA, GBC patients were older, with advanced tumors and shorter DFS. The considerable rate of re-classification stresses the need for improved preoperative staging, as these prognostic differences could have implications for treatment strategies.
Identifiants
pubmed: 37697321
doi: 10.1186/s12957-023-03171-x
pii: 10.1186/s12957-023-03171-x
pmc: PMC10494342
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
286Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Otsuka S, Ebata T, Yokoyama Y, Igami T, Mizuno T, Yamaguchi J, et al. Benign hilar bile duct strictures resected as perihilar cholangiocarcinoma. Br J Surg. 2019;106(11):1504–11.
doi: 10.1002/bjs.11257
pubmed: 31386198
Roos E, Hubers LM, Coelen RJS, Doorenspleet ME, de Vries N, Verheij J, et al. IgG4-associated cholangitis in patients resected for presumed perihilar cholangiocarcinoma: a 30-year tertiary care experience. Am J Gastroenterol. 2018;113(5):765–72.
doi: 10.1038/s41395-018-0036-5
pubmed: 29549357
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–8. discussion 828-829.
doi: 10.1097/01.sla.0000189131.90876.9e
pubmed: 16327492
pmcid: 1409891
Gilg S, Sparrelid E, Saraste L, Nowak G, Wahlin S, Stromberg C, et al. The molecular adsorbent recirculating system in posthepatectomy liver failure: Results from a prospective phase I study. Hepatol Commun. 2018;2(4):445–54.
doi: 10.1002/hep4.1167
pubmed: 29619422
pmcid: 5880195
Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215(1):31–8.
doi: 10.1097/00000658-199201000-00005
pubmed: 1309988
pmcid: 1242367
McMillan DC, Crozier JE, Canna K, Angerson WJ, McArdle CS. Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007;22(8):881–6.
doi: 10.1007/s00384-006-0259-6
pubmed: 17245566
D’Souza MA, Al-Saffar HA, Fernandez Moro C, Shtembari S, Danielsson O, Sparrelid E, et al. Redefining resection margins and dissection planes in perihilar cholangiocarcinoma-radical resection is a rare event. Virchows Arch. 2022;480(3):557–64.
doi: 10.1007/s00428-021-03231-1
pubmed: 34783866
Sobin LH, Gospodarowicz MK, Wittekind C. International Union against Cancer. TNM classification of malignant tumours. 7th ed. Chichester; Hoboken: Wiley-Blackwell; 2010.
Azizi AA, Lamarca A, McNamara MG, Valle JW. Chemotherapy for advanced gallbladder cancer (GBC): a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2021;163: 103328.
doi: 10.1016/j.critrevonc.2021.103328
pubmed: 33862244
Banales JM, Marin JJG, Lamarca A, Rodrigues PM, Khan SA, Roberts LR, et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol. 2020;17(9):557–88.
doi: 10.1038/s41575-020-0310-z
pubmed: 32606456
pmcid: 7447603
Goetze TO, Bechstein WO, Bankstahl US, Keck T, Konigsrainer A, Lang SA, et al. Neoadjuvant chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone with or without adjuvant chemotherapy in incidentally detected gallbladder carcinoma after simple cholecystectomy or in front of radical resection of BTC (ICC/ECC) - a phase III study of the German registry of incidental gallbladder carcinoma platform (GR)- the AIO/ CALGP/ ACO- GAIN-trial. BMC Cancer. 2020;20(1):122.
doi: 10.1186/s12885-020-6610-4
pubmed: 32059704
pmcid: 7023745
JCOG1920: A phase III trial of neoadjuvant Gemcitabine + Cisplatin + S-1 (GCS) vs. surgery first for resectable biliary tract cancer (NABICAT). https://jrct.niph.go.jp/en-latest-detail/jRCTs031200388 . Accessed 22 Dec 2022.
Matsuyama R, Morioka D, Mori R, Yabushita Y, Hiratani S, Ota Y, et al. Our rationale of initiating neoadjuvant chemotherapy for hilar cholangiocarcinoma: a proposal of criteria for “borderline resectable” in the field of surgery for hilar cholangiocarcinoma. World J Surg. 2019;43(4):1094–104.
doi: 10.1007/s00268-018-04883-y
pubmed: 30536024
Koea J, Holden A, Chau K, McCall J. Differential diagnosis of stenosing lesions at the hepatic hilus. World J Surg. 2004;28(5):466–70.
doi: 10.1007/s00268-004-7034-z
pubmed: 15085401
Are C, Gonen M, D’Angelica M, DeMatteo RP, Fong Y, Blumgart LH, et al. Differential diagnosis of proximal biliary obstruction. Surgery. 2006;140(5):756–63.
doi: 10.1016/j.surg.2006.03.028
pubmed: 17084718
Aloia TA, Jarufe N, Javle M, Maithel SK, Roa JC, Adsay V, et al. Gallbladder cancer: expert consensus statement. HPB (Oxford). 2015;17(8):681–90.
doi: 10.1111/hpb.12444
pubmed: 26172135
pmcid: 4527853
Balakrishnan A, Barmpounakis P, Demiris N, Jah A, Spiers HVM, Talukder S, et al. Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study. EClinicalMedicine. 2023;59: 101951.
doi: 10.1016/j.eclinm.2023.101951
pubmed: 37125405
pmcid: 10130604
de Savornin Lohman EAJ, Kuipers H, van Dooren M, Verhoeven RHA, Erdmann JI, Groot Koerkamp B, et al. Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study. HPB (Oxford). 2020;22(12):1686–94.
doi: 10.1016/j.hpb.2020.03.015
pubmed: 32340859
Franken LC, Olthof PB, Erdmann JI, van Delden OM, Verheij J, Besselink MG, et al. Short- and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma: does left or right side matter? Hepatobiliary Surg Nutr. 2021;10(2):154–62.
doi: 10.21037/hbsn-19-948
pubmed: 33898556
pmcid: 8050564
Coelen RJ, Ruys AT, Wiggers JK, Nio CY, Verheij J, Gouma DJ, et al. Development of a risk score to predict detection of metastasized or locally advanced perihilar cholangiocarcinoma at staging laparoscopy. Ann Surg Oncol. 2016;23(Suppl 5):904–10.
doi: 10.1245/s10434-016-5531-6
pubmed: 27586005
pmcid: 5149561
Rassam F, Roos E, van Lienden KP, van Hooft JE, Klumpen HJ, van Tienhoven G, et al. Modern work-up and extended resection in perihilar cholangiocarcinoma: the AMC experience. Langenbecks Arch Surg. 2018;403(3):289–307.
doi: 10.1007/s00423-018-1649-2
pubmed: 29350267
pmcid: 5986829
Nooijen LE, Swijnenburg RJ, Klumpen HJ, Verheij J, Kazemier G, van Gulik TM, et al. Surgical therapy for perihilar cholangiocarcinoma: state of the art. Visc Med. 2021;37(1):18–25.
doi: 10.1159/000514032
pubmed: 33708815
pmcid: 7923954
Victor DW, Sherman S, Karakan T, Khashab MA. Current endoscopic approach to indeterminate biliary strictures. World J Gastroenterol. 2012;18(43):6197–205.
doi: 10.3748/wjg.v18.i43.6197
pubmed: 23180939
pmcid: 3501767
Coelen RJ, Ruys AT, Besselink MG, Busch OR, van Gulik TM. Diagnostic accuracy of staging laparoscopy for detecting metastasized or locally advanced perihilar cholangiocarcinoma: a systematic review and meta-analysis. Surg Endosc. 2016;30(10):4163–73.
doi: 10.1007/s00464-016-4788-y
pubmed: 26895909
pmcid: 5009158
Primrose JN, Fox RP, Palmer DH, Malik HZ, Prasad R, Mirza D, et al. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019;20(5):663–73.
doi: 10.1016/S1470-2045(18)30915-X
pubmed: 30922733
Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81.
doi: 10.1056/NEJMoa0908721
pubmed: 20375404
Eckel F, Schmid RM. Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials. Br J Cancer. 2007;96(6):896–902.
doi: 10.1038/sj.bjc.6603648
pubmed: 17325704
pmcid: 2360111
van Keulen AM, Buettner S, Erdmann JI, Pratschke J, Ratti F, Jarnagin WR, et al. Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk? Br J Surg. 2023;110(5):599–605.
doi: 10.1093/bjs/znad057
pubmed: 36918735
pmcid: 10364519
Golse N, Nunez J, Mazzotta A, Cano L, Bergeat D, Sulpice L, et al. Personalized preoperative nomograms predicting postoperative risks after resection of perihilar cholangiocarcinoma. World J Surg. 2020;44(10):3449–60.
doi: 10.1007/s00268-020-05618-8
pubmed: 32474628
Jansson H, Cornillet M, Bjorkstrom NK, Sturesson C, Sparrelid E. Prognostic value of preoperative inflammatory markers in resectable biliary tract cancer - Validation and comparison of the Glasgow Prognostic Score and Modified Glasgow Prognostic Score in a Western cohort. Eur J Surg Oncol. 2020;46(5):804–10.
doi: 10.1016/j.ejso.2019.12.008
pubmed: 31848078
Naveed S, Qari H, Thau CM, Burasakarn P, Mir AW. Neoadjuvant chemotherapy for advanced gallbladder cancer: do we have enough evidence? A systematic review. Euroasian J Hepatogastroenterol. 2021;11(2):87–94.
doi: 10.5005/jp-journals-10018-1348
pubmed: 34786362
pmcid: 8566156
Isaji S, Mizuno S, Windsor JA, Bassi C, Fernandez-Del Castillo C, Hackert T, et al. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology. 2018;18(1):2–11.
doi: 10.1016/j.pan.2017.11.011
pubmed: 29191513
Oba A, Del Chiaro M, Satoi S, Kim SW, Takahashi H, Yu J, et al. New criteria of resectability for pancreatic cancer: a position paper by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS). J Hepatobiliary Pancreat Sci. 2022;29(7):725–31.
doi: 10.1002/jhbp.1049
pubmed: 34581016