Georg Lurje1, Jan Bednarsch2, Zoltan Czigany2, Isabella Lurje2, Ivana Katharina Schlebusch2, Joerg Boecker2, Franziska Alexandra Meister2, Frank Tacke3, Christoph Roderburg3, Marcel Den Dulk4, Nadine Therese Gaisa5, Philipp Bruners6, Ulf Peter Neumann7. 1. Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany. Electronic address: glurje@ukaachen.de. 2. Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany. 3. Department of Internal Medicine III, Division of Gastroenterology and Hepatology, University Hospital RWTH Aachen, Aachen, Germany; Charité University Medicine Berlin, Department of Gastroenterology/Hepatology, Campus Virchow Klinikum and Charité Mitte, Berlin, Germany. 4. Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, Netherlands. 5. Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany. 6. Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany. 7. Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, Netherlands.
Abstract
INTRODUCTION: Cholangiocellular carcinoma (CCA) is an aggressive malignancy with a dismal prognosis. Among curative treatment options for CCA, radical surgical resection with extrahepatic bile duct resection, hepatectomy and en-bloc lymphadenectomy are considered the mainstay of curative therapy. Here, we aimed to identify prognostic markers of clinical outcome in CCA-patients who underwent surgical resection in curative intent. MATERIAL AND METHODS: Between 2011 and 2016, 162 patients with CCA (perihilar CCA (pCCA): n = 91, intrahepatic CCA (iCCA): n = 71) underwent surgery in curative intent at our institution. Preoperative characteristics, perioperative data and oncological follow-up were obtained from a prospectively managed institutional database. The associations of overall- (OS) and disease-free-survival (DFS) with clinico-pathological characteristics were assessed using univariate and multivariable cox regression analyses. RESULTS: The median OS and DFS were 38 and 36 months for pCCA and 25 and 13 months for iCCA, respectively. Lymphovascular invasion (LVI) and lymph node metastasis as well as surgical complications as assessed by the comprehensive complication index (CCI) and tumor grading were independently associated with OS for the pCCA (LVI; RR = 2.36, p = 0.028; CCI; RR = 1.04, p < 0.001) and iCCA cohorts (N-category; RR = 3.21, p = 0.040; tumor grading; RR = 3.75, p = 0.013; CCI, RR = 4.49, p = 0.010), respectively. No other clinical variable including R0-status and Bismuth classification was associated with OS. CONCLUSION: Major liver resections for CCA are feasible and safe in experienced high-volume centers. Lymph node metastasis and LVI are associated with adverse clinical outcome, supporting the role of systematic lymphadenectomy. The assessment of LVI may be useful in identifying high-risk patients for adjuvant treatment strategies.
INTRODUCTION:Cholangiocellular carcinoma (CCA) is an aggressive malignancy with a dismal prognosis. Among curative treatment options for CCA, radical surgical resection with extrahepatic bile duct resection, hepatectomy and en-bloc lymphadenectomy are considered the mainstay of curative therapy. Here, we aimed to identify prognostic markers of clinical outcome in CCA-patients who underwent surgical resection in curative intent. MATERIAL AND METHODS: Between 2011 and 2016, 162 patients with CCA (perihilar CCA (pCCA): n = 91, intrahepatic CCA (iCCA): n = 71) underwent surgery in curative intent at our institution. Preoperative characteristics, perioperative data and oncological follow-up were obtained from a prospectively managed institutional database. The associations of overall- (OS) and disease-free-survival (DFS) with clinico-pathological characteristics were assessed using univariate and multivariable cox regression analyses. RESULTS: The median OS and DFS were 38 and 36 months for pCCA and 25 and 13 months for iCCA, respectively. Lymphovascular invasion (LVI) and lymph node metastasis as well as surgical complications as assessed by the comprehensive complication index (CCI) and tumor grading were independently associated with OS for the pCCA (LVI; RR = 2.36, p = 0.028; CCI; RR = 1.04, p < 0.001) and iCCA cohorts (N-category; RR = 3.21, p = 0.040; tumor grading; RR = 3.75, p = 0.013; CCI, RR = 4.49, p = 0.010), respectively. No other clinical variable including R0-status and Bismuth classification was associated with OS. CONCLUSION: Major liver resections for CCA are feasible and safe in experienced high-volume centers. Lymph node metastasis and LVI are associated with adverse clinical outcome, supporting the role of systematic lymphadenectomy. The assessment of LVI may be useful in identifying high-risk patients for adjuvant treatment strategies.
Authors: Jan Bednarsch; Zoltan Czigany; Isabella Lurje; Pavel Strnad; Philipp Bruners; Tom Florian Ulmer; Marcel den Dulk; Georg Lurje; Ulf Peter Neumann Journal: Langenbecks Arch Surg Date: 2019-11-16 Impact factor: 3.445
Authors: Isabella Lurje; Zoltan Czigany; Jan Bednarsch; Nadine Therese Gaisa; Edgar Dahl; Ruth Knüchel; Hannah Miller; Tom Florian Ulmer; Pavel Strnad; Christian Trautwein; Frank Tacke; Ulf Peter Neumann; Georg Lurje Journal: Liver Cancer Date: 2022-01-25 Impact factor: 12.430
Authors: Jan Bednarsch; Zoltan Czigany; Samara Sharmeen; Gregory van der Kroft; Pavel Strnad; Tom Florian Ulmer; Peter Isfort; Philipp Bruners; Georg Lurje; Ulf Peter Neumann Journal: World J Surg Oncol Date: 2020-06-24 Impact factor: 2.754
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Authors: Daniele Dondossola; Michele Ghidini; Francesco Grossi; Giorgio Rossi; Diego Foschi Journal: World J Gastroenterol Date: 2020-07-07 Impact factor: 5.742