Thuy B Tran1, Cecilia G Ethun2, Timothy M Pawlik3,4, Carl Schmidt4, Eliza W Beal4, Ryan C Fields5, Bradley Krasnick5, Sharon M Weber6, Ahmed Salem6, Robert C G Martin7, Charles R Scoggins7, Perry Shen8, Harveshp D Mogal8, Kamran Idrees9, Chelsea A Isom9, Ioannis Hatzaras10, Rivfka Shenoy10, Shishir K Maithel2, George A Poultsides11. 1. Department of Surgery, Stanford University, Stanford, CA, USA. 2. Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 3. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. 4. Department of Surgery, The Ohio State University, Columbus, OH, USA. 5. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. 6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 7. Department of Surgery, University of Louisville, Louisville, KY, USA. 8. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 9. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 10. Department of Surgery, New York University, New York, NY, USA. 11. Department of Surgery, Stanford University, Stanford, CA, USA. gpoultsides@stanford.edu.
Abstract
BACKGROUND: The prevalence and characteristics of actual 5-year survivors after surgical treatment of hilar cholangiocarcinoma (HC) have not been described previously. METHODS: Patients who underwent resection for HC from 2000 to 2015 were analyzed through a multi-institutional registry from 10 U.S. academic medical centers. The clinicopathologic characteristics and both the perioperative and long-term outcomes for actual 5-year survivors were compared with those for non-survivors (patients who died within 5 years after surgery). Patients alive at last encounter who had a follow-up period shorter than 5 years were excluded from the study. RESULTS: The study identified 257 patients with HC who underwent curative-intent resection with an actuarial 5-year survival of 19%. Of 194 patients with a follow-up period longer than 5 years, 23 (12%) were 5-year survivors. Compared with non-survivors, the 5-year survivors had a lower median pretreatment CA 19-9 level (116 vs. 34 U/L; P = 0.008) and a lower rate of lymph node involvement (42% vs. 15%; P = 0.027) and R1 margins (39% vs. 17%; P = 0.042). However, the sole presence of these factors did not preclude a 5-year survival after surgery. The frequencies of bile duct resection alone, major hepatectomy, caudate lobe resection, portal vein or hepatic artery resection, preoperative biliary sepsis, intraoperative blood transfusion, serious postoperative complications, and receipt of adjuvant chemotherapy were comparable between the two groups. CONCLUSIONS: One in eight patients with HC reaches the 5-year survival milestone after resection. A 5-year survival can be achieved even in the presence of traditionally unfavorable clinicopathologic factors (elevated CA 19-9, nodal metastasis, and R1 margins).
BACKGROUND: The prevalence and characteristics of actual 5-year survivors after surgical treatment of hilar cholangiocarcinoma (HC) have not been described previously. METHODS:Patients who underwent resection for HC from 2000 to 2015 were analyzed through a multi-institutional registry from 10 U.S. academic medical centers. The clinicopathologic characteristics and both the perioperative and long-term outcomes for actual 5-year survivors were compared with those for non-survivors (patients who died within 5 years after surgery). Patients alive at last encounter who had a follow-up period shorter than 5 years were excluded from the study. RESULTS: The study identified 257 patients with HC who underwent curative-intent resection with an actuarial 5-year survival of 19%. Of 194 patients with a follow-up period longer than 5 years, 23 (12%) were 5-year survivors. Compared with non-survivors, the 5-year survivors had a lower median pretreatment CA 19-9 level (116 vs. 34 U/L; P = 0.008) and a lower rate of lymph node involvement (42% vs. 15%; P = 0.027) and R1 margins (39% vs. 17%; P = 0.042). However, the sole presence of these factors did not preclude a 5-year survival after surgery. The frequencies of bile duct resection alone, major hepatectomy, caudate lobe resection, portal vein or hepatic artery resection, preoperative biliary sepsis, intraoperative blood transfusion, serious postoperative complications, and receipt of adjuvant chemotherapy were comparable between the two groups. CONCLUSIONS: One in eight patients with HC reaches the 5-year survival milestone after resection. A 5-year survival can be achieved even in the presence of traditionally unfavorable clinicopathologic factors (elevated CA 19-9, nodal metastasis, and R1 margins).
Authors: Sung Ho Lee; Gi Hong Choi; Dai Hoon Han; Kyung Sik Kim; Jin Sub Choi; Seoung Yoon Rho Journal: Ann Hepatobiliary Pancreat Surg Date: 2021-02-28
Authors: T Sugiura; K Uesaka; Y Okamura; T Ito; Y Yamamoto; R Ashida; K Ohgi; S Otsuka; M Nakagawa; T Aramaki; K Asakura Journal: BJS Open Date: 2021-07-06