Background Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. Methods Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. Results Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). Conclusions In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.

Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group / Ruzzenente, Andrea; Bagante, Fabio; Olthof, Pim B; Aldrighetti, Luca; Alikhanov, Ruslan; Cescon, Matteo; Koerkamp, Bas Groot; Jarnagin, William R; Nadalin, Silvio; Pratschke, Johann; Schmelzle, Moritz; Sparrelid, Ernesto; Lang, Hauke; Iacono, Calogero; van Gulik, Thomas M; Guglielmi, Alfredo; Andreou, A; Bartsch, F; Benzing, C; Buettner, S; Campagnaro, T; Capobianco, I; Charco, R; de Reuver, P; De, Savornin; Lohman, E; Nijmegen, ; Dejong, Chc; Efanov, M; Erdmann, Ji; Franken, Lc; Giovinazzo, G; Giglio, Mc; Gomez-Gavara, C; Heid, F; Ijzermans, Jnm; Isaac, J; Jansson, H; Ligthart, Map; Maithel, Sk; Malago` M., Malik HZ; Muiesan, P; Olde Damink, Swm; Quinn, Lm; Ratti, F; Ravaioli, M; Rolinger, J; Schadde, E; Serenari, M; Troisi, R; van Laarhoven, S; van Vugt, Jla. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - (2021). [10.1245/s10434-021-09905-z]

Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group

Giglio MC
Membro del Collaboration Group
;
Troisi R
Membro del Collaboration Group
;
2021

Abstract

Background Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. Methods Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. Results Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). Conclusions In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.
2021
Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group / Ruzzenente, Andrea; Bagante, Fabio; Olthof, Pim B; Aldrighetti, Luca; Alikhanov, Ruslan; Cescon, Matteo; Koerkamp, Bas Groot; Jarnagin, William R; Nadalin, Silvio; Pratschke, Johann; Schmelzle, Moritz; Sparrelid, Ernesto; Lang, Hauke; Iacono, Calogero; van Gulik, Thomas M; Guglielmi, Alfredo; Andreou, A; Bartsch, F; Benzing, C; Buettner, S; Campagnaro, T; Capobianco, I; Charco, R; de Reuver, P; De, Savornin; Lohman, E; Nijmegen, ; Dejong, Chc; Efanov, M; Erdmann, Ji; Franken, Lc; Giovinazzo, G; Giglio, Mc; Gomez-Gavara, C; Heid, F; Ijzermans, Jnm; Isaac, J; Jansson, H; Ligthart, Map; Maithel, Sk; Malago` M., Malik HZ; Muiesan, P; Olde Damink, Swm; Quinn, Lm; Ratti, F; Ravaioli, M; Rolinger, J; Schadde, E; Serenari, M; Troisi, R; van Laarhoven, S; van Vugt, Jla. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - (2021). [10.1245/s10434-021-09905-z]
File in questo prodotto:
File Dimensione Formato  
Ruzzenente2021_Article_SurgeryForBismuth-CorletteType.pdf

accesso aperto

Tipologia: Documento in Pre-print
Licenza: Dominio pubblico
Dimensione 392.19 kB
Formato Adobe PDF
392.19 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/856154
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 23
  • ???jsp.display-item.citation.isi??? 19
social impact