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Erschienen in: Annals of Surgical Oncology 9/2019

17.05.2019 | Hepatobiliary Tumors

Cholangiographic Tumor Classification for Simple Patient Selection Prior to Hepatopancreatoduodenectomy for Cholangiocarcinoma

verfasst von: Yoshitaka Toyoda, MD, Tomoki Ebata, MD, Takashi Mizuno, MD, Yukihiro Yokoyama, MD, Tsuyoshi Igami, MD, Junpei Yamaguchi, MD, Shunsuke Onoe, MD, Nobuyuki Watanabe, MD, Masato Nagino, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2019

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Abstract

Background

Hepatopancreatoduodenectomy (HPD) is employed for patients with laterally advanced cholangiocarcinoma. However, the survival benefit of this extended approach remains controversial. The aim of this study is to identify a tumor feature benefiting from HPD from the standpoint of long-term survival.

Patients and Methods

Patients with cholangiocarcinoma who underwent HPD with curative intent between 2001 and 2017 were retrospectively analyzed. Tumors were radiologically classified by preoperative cholangiogram. Diffuse type was defined as significant tumor/stricture located from the hilar to intrapancreatic duct; localized type was defined as tumor otherwise. Univariable and multivariable analyses were performed to identify prognostic indicators.

Results

Of 100 study patients, 28 (28%) patients had diffuse tumor type, while the remaining 72 (72%) patients had localized tumors. The former group showed significantly longer lateral length (43 versus 22 mm, P < 0.001) and more frequent pancreatic invasion (50% versus 32%, P = 0.110), advanced T classification (64% versus 49%, P = 0.185), and nodal metastasis (57% versus 47%, P = 0.504), compared with the latter group. The survival for patients with diffuse tumor type was significantly worse than that for patients with localized tumor type, with 5-year survival rates of 59.0% versus 26.3%, respectively (P = 0.003). Multivariable analysis identified four independent factors deteriorating long-term survival: cholangiographic diffuse tumor (P = 0.021), higher age (P = 0.020), percutaneous biliary drainage (P = 0.007), and portal vein resection (P = 0.007).

Conclusions

Presurgical cholangiographic classification, diffuse or localized type, is a tumor-related factor closely associated with survival probability; therefore, it may be a useful feature for patient selection prior to HPD for cholangiocarcinoma.
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Literatur
1.
Zurück zum Zitat Ebata T, Yokoyama Y, Igami T, et al. Review of hepatopancreatoduodenectomy for biliary cancer: an extended radical approach of Japanese origin. J Hepatobiliary Pancreat Sci. 2014;21:550–5.CrossRefPubMed Ebata T, Yokoyama Y, Igami T, et al. Review of hepatopancreatoduodenectomy for biliary cancer: an extended radical approach of Japanese origin. J Hepatobiliary Pancreat Sci. 2014;21:550–5.CrossRefPubMed
2.
Zurück zum Zitat Ebata T, Yokoyama Y, Igami T, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg. 2012;256:297–305.CrossRefPubMed Ebata T, Yokoyama Y, Igami T, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg. 2012;256:297–305.CrossRefPubMed
3.
Zurück zum Zitat Nimura Y, Hayakawa N, Kamiya J, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991;38:170–5.PubMed Nimura Y, Hayakawa N, Kamiya J, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991;38:170–5.PubMed
4.
Zurück zum Zitat Tsukada K, Yoshida K, Aono T, et al. Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract. Br J Surg. 1994;81:108–10.CrossRefPubMed Tsukada K, Yoshida K, Aono T, et al. Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract. Br J Surg. 1994;81:108–10.CrossRefPubMed
5.
Zurück zum Zitat Ebata T, Nagino M, Nishio H, et al. Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg. 2007;14:131–5.CrossRefPubMed Ebata T, Nagino M, Nishio H, et al. Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg. 2007;14:131–5.CrossRefPubMed
6.
Zurück zum Zitat Aoki T, Sakamoto Y, Kohno Y, et al. Hepatopancreaticoduodenectomy for biliary cancer: strategies for near-zero operative mortality and acceptable long-term outcome. Ann Surg. 2018;267:332–7.CrossRefPubMed Aoki T, Sakamoto Y, Kohno Y, et al. Hepatopancreaticoduodenectomy for biliary cancer: strategies for near-zero operative mortality and acceptable long-term outcome. Ann Surg. 2018;267:332–7.CrossRefPubMed
7.
Zurück zum Zitat Otsubo T, Kobayashi S, Sano K, et al. Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons. J Hepatobiliary Pancreat Sci. 2017;24:252–61.CrossRefPubMed Otsubo T, Kobayashi S, Sano K, et al. Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons. J Hepatobiliary Pancreat Sci. 2017;24:252–61.CrossRefPubMed
8.
Zurück zum Zitat Tran TB, Dua MM, Spain DA, et al. Hepato-pancreatectomy: how morbid? Results from the national surgical quality improvement project. HPB (Oxford). 2015;17:763–9.CrossRefPubMedPubMedCentral Tran TB, Dua MM, Spain DA, et al. Hepato-pancreatectomy: how morbid? Results from the national surgical quality improvement project. HPB (Oxford). 2015;17:763–9.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Fernandes Ede S, Mello FT, Ribeiro-Filho J, et al. The largest Western experience with hepatopancreatoduodenectomy: lessons learned with 35 cases. Arq Bras Cir Dig. 2016;29:17–20.CrossRefPubMed Fernandes Ede S, Mello FT, Ribeiro-Filho J, et al. The largest Western experience with hepatopancreatoduodenectomy: lessons learned with 35 cases. Arq Bras Cir Dig. 2016;29:17–20.CrossRefPubMed
10.
Zurück zum Zitat Kaneoka Y, Yamaguchi A, Isogai M. Hepatopancreatoduodenectomy: its suitability for bile duct cancer versus gallbladder cancer. J Hepatobiliary Pancreat Surg. 2007;14:142–8.CrossRefPubMed Kaneoka Y, Yamaguchi A, Isogai M. Hepatopancreatoduodenectomy: its suitability for bile duct cancer versus gallbladder cancer. J Hepatobiliary Pancreat Surg. 2007;14:142–8.CrossRefPubMed
11.
Zurück zum Zitat Sakamoto Y, Nara S, Kishi Y, et al. Is extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer? Surgery. 2013;153:794–800.CrossRefPubMed Sakamoto Y, Nara S, Kishi Y, et al. Is extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer? Surgery. 2013;153:794–800.CrossRefPubMed
12.
Zurück zum Zitat Kawashima H, Itoh A, Ohno E, et al. Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: a retrospective study of efficacy and risk factors related to complications. Ann Surg. 2013;257:121–7.CrossRefPubMed Kawashima H, Itoh A, Ohno E, et al. Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: a retrospective study of efficacy and risk factors related to complications. Ann Surg. 2013;257:121–7.CrossRefPubMed
13.
Zurück zum Zitat Kawashima H, Itoh A, Ohno E, et al. Diagnostic and prognostic value of immunohistochemical expression of S100P and IMP3 in transpapillary biliary forceps biopsy samples of extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci. 2013;20:441–7.CrossRefPubMed Kawashima H, Itoh A, Ohno E, et al. Diagnostic and prognostic value of immunohistochemical expression of S100P and IMP3 in transpapillary biliary forceps biopsy samples of extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci. 2013;20:441–7.CrossRefPubMed
14.
Zurück zum Zitat Edgemen SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMed Edgemen SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMed
15.
Zurück zum Zitat Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7.CrossRefPubMedPubMedCentral Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Nagino M, Nimura Y, Nishio H, et al. 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.CrossRefPubMed Nagino M, Nimura Y, Nishio H, et al. 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.CrossRefPubMed
17.
Zurück zum Zitat Ebata T, Mizuno T, Yokoyama Y, et al. Surgical resection for Bismuth type IV perihilar cholangiocarcinoma. Br J Surg. 2018;105:829–38.CrossRefPubMed Ebata T, Mizuno T, Yokoyama Y, et al. Surgical resection for Bismuth type IV perihilar cholangiocarcinoma. Br J Surg. 2018;105:829–38.CrossRefPubMed
18.
Zurück zum Zitat Mizuno T, Ebata T, Yokoyama Y, et al. Adjuvant gemcitabine monotherapy for resectable perihilar cholangiocarcinoma with lymph node involvement: a propensity score matching analysis. Surg Today. 2017;47:182–92.CrossRefPubMed Mizuno T, Ebata T, Yokoyama Y, et al. Adjuvant gemcitabine monotherapy for resectable perihilar cholangiocarcinoma with lymph node involvement: a propensity score matching analysis. Surg Today. 2017;47:182–92.CrossRefPubMed
19.
Zurück zum Zitat Ebata T, Watanabe H, Ajioka Y, et al. Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg. 2002;89:1260–7.CrossRefPubMed Ebata T, Watanabe H, Ajioka Y, et al. Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg. 2002;89:1260–7.CrossRefPubMed
20.
Zurück zum Zitat Igami T, Nagino M, Oda K, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg. 2009;249:296–302.CrossRefPubMed Igami T, Nagino M, Oda K, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg. 2009;249:296–302.CrossRefPubMed
21.
Zurück zum Zitat Onoe S, Shimoyama Y, Ebata T, et al. Prognostic delineation of papillary cholangiocarcinoma based on the invasive proportion: a single-institution study with 184 patients. Surgery. 2014;155:280–91.CrossRefPubMed Onoe S, Shimoyama Y, Ebata T, et al. Prognostic delineation of papillary cholangiocarcinoma based on the invasive proportion: a single-institution study with 184 patients. Surgery. 2014;155:280–91.CrossRefPubMed
22.
Zurück zum Zitat Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227:405–11.CrossRefPubMedPubMedCentral Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227:405–11.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer. 2005;103:1210–6.CrossRefPubMed Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer. 2005;103:1210–6.CrossRefPubMed
24.
Zurück zum Zitat Wakai T, Shirai Y, Tsuchiya Y, et al. Combined major hepatectomy and pancreaticoduodenectomy for locally advanced biliary carcinoma: long-term results. World J Surg. 2008;32:1067–74.CrossRefPubMed Wakai T, Shirai Y, Tsuchiya Y, et al. Combined major hepatectomy and pancreaticoduodenectomy for locally advanced biliary carcinoma: long-term results. World J Surg. 2008;32:1067–74.CrossRefPubMed
25.
Zurück zum Zitat Hirano S, Tanaka E, Tsuchikawa T, et al. Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2014;21:533–40.CrossRefPubMed Hirano S, Tanaka E, Tsuchikawa T, et al. Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2014;21:533–40.CrossRefPubMed
26.
Zurück zum Zitat Komaya K, Ebata T, Fukami Y, et al. Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma. J Gastroenterol. 2016;51:608–19.CrossRefPubMed Komaya K, Ebata T, Fukami Y, et al. Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma. J Gastroenterol. 2016;51:608–19.CrossRefPubMed
27.
Zurück zum Zitat Komaya K, Ebata T, Yokoyama Y, et al. Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage: a propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery. 2017;161:394–404.CrossRefPubMed Komaya K, Ebata T, Yokoyama Y, et al. Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage: a propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery. 2017;161:394–404.CrossRefPubMed
28.
Zurück zum Zitat Park MS, Kim TK, Kim KW, et al. Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 2004;233:234–40.CrossRefPubMed Park MS, Kim TK, Kim KW, et al. Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 2004;233:234–40.CrossRefPubMed
29.
Zurück zum Zitat Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning. Abdom Imaging. 2008;33:444–51.CrossRefPubMed Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning. Abdom Imaging. 2008;33:444–51.CrossRefPubMed
30.
Zurück zum Zitat McGahan JP, Phillips HE, Cox KL. Sonography of the normal pediatric gallbladder and biliary tract. Radiology. 1982;144:873–5.CrossRefPubMed McGahan JP, Phillips HE, Cox KL. Sonography of the normal pediatric gallbladder and biliary tract. Radiology. 1982;144:873–5.CrossRefPubMed
31.
Zurück zum Zitat Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61:1657–69.CrossRefPubMed Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61:1657–69.CrossRefPubMed
32.
Zurück zum Zitat Noji T, Kondo S, Hirano S, et al. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer. Br J Surg. 2008;95:92–6.CrossRefPubMed Noji T, Kondo S, Hirano S, et al. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer. Br J Surg. 2008;95:92–6.CrossRefPubMed
33.
Zurück zum Zitat Sugiura T, Nishio H, Nagino M, et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg. 2008;32:1478–84.CrossRefPubMed Sugiura T, Nishio H, Nagino M, et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg. 2008;32:1478–84.CrossRefPubMed
34.
Zurück zum Zitat Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–81.CrossRefPubMed Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–81.CrossRefPubMed
35.
Zurück zum Zitat Bridgewater J, Lopes A, Wasan H, et al. Prognostic factors for progression-free and overall survival in advanced biliary tract cancer. Ann Oncol. 2016;27:134–40.CrossRefPubMed Bridgewater J, Lopes A, Wasan H, et al. Prognostic factors for progression-free and overall survival in advanced biliary tract cancer. Ann Oncol. 2016;27:134–40.CrossRefPubMed
36.
Zurück zum Zitat Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.CrossRefPubMed Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.CrossRefPubMed
Metadaten
Titel
Cholangiographic Tumor Classification for Simple Patient Selection Prior to Hepatopancreatoduodenectomy for Cholangiocarcinoma
verfasst von
Yoshitaka Toyoda, MD
Tomoki Ebata, MD
Takashi Mizuno, MD
Yukihiro Yokoyama, MD
Tsuyoshi Igami, MD
Junpei Yamaguchi, MD
Shunsuke Onoe, MD
Nobuyuki Watanabe, MD
Masato Nagino, MD
Publikationsdatum
17.05.2019
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 9/2019
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07457-x

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