Xu-Feng Zhang1, Fabio Bagante2, Qinyu Chen3, Eliza W Beal3, Yi Lv4, Matthew Weiss5, Irinel Popescu6, Hugo P Marques7, Luca Aldrighetti8, Shishir K Maithel9, Carlo Pulitano10, Todd W Bauer11, Feng Shen12, George A Poultsides13, Olivier Soubrane14, Guillaume Martel15, B Groot Koerkamp16, Alfredo Guglielmi17, Endo Itaru18, Timothy M Pawlik19. 1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Surgery, University of Verona, Verona, Italy. 3. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 4. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 5. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 6. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 7. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 8. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 9. Department of Surgery, Emory University, Atlanta, GA, USA. 10. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 11. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 12. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 13. Department of Surgery, Stanford University, Stanford, CA, USA. 14. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 15. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 16. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. 17. Department of Surgery, University of Verona, Verona, Italy. 18. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. 19. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: tim.pawlik@osumc.edu.
Abstract
BACKGROUND: Intrahepatic cholangiocarcinoma with hepatic hilus involvement has been either classified as intrahepatic cholangiocarcinoma or hilar cholangiocarcinoma. The present study aimed to investigate the clinicopathologic characteristics and short- and long-term outcomes after curative resection for hilar type intrahepatic cholangiocarcinoma in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma. METHODS: A total of 912 patients with mass-forming peripheral intrahepatic cholangiocarcinoma, 101 patients with hilar type intrahepatic cholangiocarcinoma, and 159 patients with hilar cholangiocarcinoma undergoing curative resection from 2000 to 2015 were included from two multi-institutional databases. Clinicopathologic characteristics and short- and long-term outcomes were compared among the 3 groups. RESULTS: Patients with hilar type intrahepatic cholangiocarcinoma had more aggressive tumor characteristics (eg, higher frequency of vascular invasion and lymph nodes metastasis) and experienced more extensive resections in comparison with either peripheral intrahepatic cholangiocarcinoma or hilar cholangiocarcinoma patients. The odds of lymphadenectomy and R0 resection rate among patients with hilar type intrahepatic cholangiocarcinoma were comparable with hilar cholangiocarcinoma patients, but higher than peripheral intrahepatic cholangiocarcinoma patients (lymphadenectomy incidence, 85.1% vs 42.5%, P < .001; R0 rate, 75.2% vs 88.8%, P < .001). After curative surgery, patients with hilar type intrahepatic cholangiocarcinoma experienced a higher rate of technical-related complications compared with peripheral intrahepatic cholangiocarcinoma patients. Of note, hilar type intrahepatic cholangiocarcinoma was associated with worse disease-specific survival and recurrence-free survival after curative resection versus peripheral intrahepatic cholangiocarcinoma (median disease-specific survival, 26.0 vs 54.0 months, P < .001; median recurrence-free survival, 13.0 vs 18.0 months, P = .021) and hilar cholangiocarcinoma (median disease-specific survival, 26.0 vs 49.0 months, P = .003; median recurrence-free survival, 13.0 vs 33.4 months, P < .001). CONCLUSION: Mass-forming intrahepatic cholangiocarcinoma with hepatic hilus involvement is a more aggressive type of cholangiocarcinoma, which showed distinct clinicopathologic characteristics, worse long-term outcomes after curative resection, in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma.
BACKGROUND:Intrahepatic cholangiocarcinoma with hepatic hilus involvement has been either classified as intrahepatic cholangiocarcinoma or hilar cholangiocarcinoma. The present study aimed to investigate the clinicopathologic characteristics and short- and long-term outcomes after curative resection for hilar type intrahepatic cholangiocarcinoma in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma. METHODS: A total of 912 patients with mass-forming peripheral intrahepatic cholangiocarcinoma, 101 patients with hilar type intrahepatic cholangiocarcinoma, and 159 patients with hilar cholangiocarcinoma undergoing curative resection from 2000 to 2015 were included from two multi-institutional databases. Clinicopathologic characteristics and short- and long-term outcomes were compared among the 3 groups. RESULTS:Patients with hilar type intrahepatic cholangiocarcinoma had more aggressive tumor characteristics (eg, higher frequency of vascular invasion and lymph nodes metastasis) and experienced more extensive resections in comparison with either peripheral intrahepatic cholangiocarcinoma or hilar cholangiocarcinomapatients. The odds of lymphadenectomy and R0 resection rate among patients with hilar type intrahepatic cholangiocarcinoma were comparable with hilar cholangiocarcinomapatients, but higher than peripheral intrahepatic cholangiocarcinomapatients (lymphadenectomy incidence, 85.1% vs 42.5%, P < .001; R0 rate, 75.2% vs 88.8%, P < .001). After curative surgery, patients with hilar type intrahepatic cholangiocarcinoma experienced a higher rate of technical-related complications compared with peripheral intrahepatic cholangiocarcinomapatients. Of note, hilar type intrahepatic cholangiocarcinoma was associated with worse disease-specific survival and recurrence-free survival after curative resection versus peripheral intrahepatic cholangiocarcinoma (median disease-specific survival, 26.0 vs 54.0 months, P < .001; median recurrence-free survival, 13.0 vs 18.0 months, P = .021) and hilar cholangiocarcinoma (median disease-specific survival, 26.0 vs 49.0 months, P = .003; median recurrence-free survival, 13.0 vs 33.4 months, P < .001). CONCLUSION: Mass-forming intrahepatic cholangiocarcinoma with hepatic hilus involvement is a more aggressive type of cholangiocarcinoma, which showed distinct clinicopathologic characteristics, worse long-term outcomes after curative resection, in comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma.
Authors: Lu Wu; Diamantis I Tsilimigras; Anghela Z Paredes; Rittal Mehta; J Madison Hyer; Katiuscha Merath; Kota Sahara; Fabio Bagante; Eliza W Beal; Feng Shen; Timothy M Pawlik Journal: World J Surg Date: 2019-07 Impact factor: 3.352
Authors: Daniel R Waisberg; Rafael S Pinheiro; Lucas S Nacif; Vinicius Rocha-Santos; Rodrigo B Martino; Rubens M Arantes; Liliana Ducatti; Quirino Lai; Wellington Andraus; Luiz C D'Albuquerque Journal: Transl Gastroenterol Hepatol Date: 2018-09-12