Long-term Survival after resection for perihilar cholangiocarcinoma: Impact of UICC staging and surgical procedure

Background/Aims: Perihilar cholangiocarcinoma is a rare disease with unfavorable prognosis resulting in low survival rates. This study aims to retrospectively assess the beneficial histopathological features and surgical procedures in long-term survivors (i.e., patients surviving perihilar cholangio...

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Bibliographic Details
Published in:The Turkish journal of gastroenterology 2019-05, Vol.30 (5), p.454-460
Main Authors: Juntermanns, Benjamin, Kaiser, Gernot Maximillian, Reis, Henning, Gries, Silvia, Kasper, Stefan, Paul, Andreas, Canbay, Ali, Fingas, Christian Dominik
Format: Article
Language:English
Subjects:
Bismuth
Comparative analysis
Metastasis
Original
Patient outcomes
Prognosis
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Summary:Background/Aims: Perihilar cholangiocarcinoma is a rare disease with unfavorable prognosis resulting in low survival rates. This study aims to retrospectively assess the beneficial histopathological features and surgical procedures in long-term survivors (i.e., patients surviving perihilar cholangiocarcinoma for at least 2 y). Material and Methods: In total, 322 patients with perihilar cholangiocarcinoma underwent surgery at our center. The follow-up ended in 2017; 76 patients survived for >2 y. The type of resection, UICC stage, and histopathological features were compared between three survival groups (>2-3, >3-5, and >5 y). Results: The >5-year-survival rate in our selected study cohort was 43.4% (>3-5 y,31.6% and >2-3 y, 25.0%), and 14.5% of the patients survived for >10 y after surgery. Patients with non-regional lymph node positive tumors and/or distant metastasis (i.e., UICC stage IVb; p=0.0112), R2 status (p=0.0288), and exploratory laparotomy only (p=0.0157) showed the poorest survival rates. Perineural invasion had no significant impact on the overall survival. However, 29.0% patients surviving for >5 y displayed the lowest perineural infiltration prevalence. Interestingly, Bismuth-Corlette stage IIIa (p=0.0467), especially caudate lobectomy (p=0.0034), was associated with disease-specific overall survival of >5y. Conclusion: Complete/extended tumor resection with additional caudate lobe resection is strongly associated with long-term survival. Perineural infiltration as a negative prognostic marker for prolonged survival needs to be evaluated in larger study cohorts. Keywords: Klatskin tumor, long-term survival, caudate lobectomy, Bismuth-Corlette classification, perineural invasion
ISSN:1300-4948
2148-5607
DOI:10.5152/tjg.2019.18275