Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion

Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Wataru Izumo, Takehiro Ota, Kosuke Kiyohara, Toru Furukawa, Hiroto Egawa, Masakazu Yamamoto

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2 Citations (Scopus)

Abstract

Purpose: To investigate short- and long-term surgical outcomes for patients with perihilar cholangiocarcinoma and vascular invasion. Methods: Data from 249 patients who underwent perihilar cholangiocarcinoma surgery between 2000 and 2016 were retrospectively analyzed. Patient evaluations included short-term surgical outcomes following vascular resection and long-term outcomes in cases with histopathological vascular invasion. Results: Mortality was 3.6% overall; 16% for hepatic artery resections, 5.4% for portal vein resections, and 1.7% in the absence of vascular resection (p = 0.029). No between-group differences were observed in the incidence of Clavien–Dindo grade ≥ 3 complications. The factors related to perioperative mortality were hepatic artery resection (odds ratio [OR] = 25.5), right trisectionectomy (OR = 13.0), and central bisectionectomy (OR = 13.8). Multivariate analysis for overall survival identified several prognostic factors: carcinoembryonic antigen level ≥ 5 ng/mL (hazard ratio [HR] = 1.68), poor differentiation (HR = 2.39), distant metastasis (HR = 1.97), and R1 invasive resection (HR = 2.13). Five-year overall survival for patients with portal vein invasion and M0R0/1cis was 35.6%, significantly worse than the 53.4% for patients with no portal vein invasion and M0R/1cis but better than the 0% for patients with portal vein invasion and M1 or R1. Those with hepatic arterial invasion and M0R0/1cis were 24.7%, significantly worse than the 53.4% for patients with no hepatic arterial invasion and M0R0/1cis but significantly better than the 0% for patients with hepatic arterial invasion and M1 or R1. Conclusion: Short-term outcomes for patients with perihilar cholangiocarcinoma and undergoing vascular resection were poor compared to those without vascular resection. Long-term survival in R0M0 disease was more favorable; aggressive surgery is recommended.

Original languageEnglish
Pages (from-to)1443-1453
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume23
Issue number7
DOIs
Publication statusPublished - 2019 Jul 15

Keywords

  • Perihilar cholangiocarcinoma
  • Surgical treatment
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Higuchi, R., Yazawa, T., Uemura, S., Izumo, W., Ota, T., Kiyohara, K., Furukawa, T., Egawa, H., & Yamamoto, M. (2019). Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion. Journal of Gastrointestinal Surgery, 23(7), 1443-1453. https://doi.org/10.1007/s11605-018-3948-x