[en] [en] BACKGROUND: Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy.
METHODS: Patients with a diagnosis of pCCA between 1997-2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS.
RESULTS: Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55-1.07).
CONCLUSIONS: Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.
Disciplines :
Surgery Oncology Gastroenterology & hepatology
Author, co-author :
van Keulen, Anne-Marleen; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Buettner, Stefan; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Olthof, Pim B; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. p.olthof@erasmusmc.nl
Klümpen, Heinz-Josef; Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Erdmann, Joris I; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Izquierdo-Sanchez, Laura; Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastian, Spain ; National Institute for the Study of Liver and Gastrointestinal Diseases, Instituto de Salud Carlos III" (ISCIII), CIBERehd, Madrid, Spain
Banales, Jesus M; Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastian, Spain ; National Institute for the Study of Liver and Gastrointestinal Diseases, Instituto de Salud Carlos III" (ISCIII), CIBERehd, Madrid, Spain ; Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain ; Basque Foundation for Science, Bilbao, Spain
Goeppert, Benjamin; Institute of Pathology and Neuropathology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany ; Institute of Pathology, Kantonsspital Baselland, Liestal, Switzerland ; Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
Roessler, Stephanie; Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
Zieniewicz, Krzysztof; Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
Lamarca, Angela; Department of Oncology - OncoHealth Institute, Fundación Jiménez Díaz University Hospital, Madrid, Spain ; Department of Medical Oncology, The Christie NHS Foundation, Manchester, England ; Division of Cancer Sciences, University of Manchester, Manchester, UK
Valle, Juan W; Department of Medical Oncology, The Christie NHS Foundation, Manchester, England ; Division of Cancer Sciences, University of Manchester, Manchester, UK
La Casta, Adelaida; Medical Oncology Department, OSI Donostialdea/Biodonostia, San Sebastián, Spain
Hoogwater, Frederik J H; University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Donadon, Matteo; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Scheiter, Alexander; Institute of Pathology, University of Regensburg, Regensburg, Germany
Marzioni, Marco; Clinic of Gastroenterology and Hepatology, Universita Politecnica delle Marche, Ancona, Italy
Adeva, Jorge; Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
Kiudeliene, Edita; Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Fernández, Jesús María Urman; Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
Vidili, Gianpaolo; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy ; Department of Internal Medicine, Day Hospital of the Medical Area, Azienda Ospedaliero Universitaria, AOU, Sassari, Italy
Mocan, Tudor; Babeș-Bolyai University - UBB Med Department, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
Fabris, Luca; Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy ; Digestive Disease Section, Yale University School of Medicine, New Haven, CT, USA
Krawczyk, Marcin; Laboratory of Metabolic Liver Diseases, Medical University of Warsaw, Warsaw, Poland ; Department of Medicine II, Saarland University Medical Center, Homburg, Germany
Folseraas, Trine; Section of Gastroenterology and the Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
Dopazo, Cristina; Department of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
Voiosu, Theodor; Gastroenterology Department, Faculty of Medicine, Colentina Clinical Hospital, UMF Carol Davila, Bucharest, Romania
Scripcariu, Viorel; University of Medicine and Pharmacy "Gr T Popa", Regional Institute of Oncology, Iasi, Romania
Biancaniello, Francesca; Department of Translational and Precision Medicine, Sapienza" University of Rome, Rome, Italy
Braconi, Chiara; Royal Marsden NHS Trust, London, Surrey, UK ; Beatson West of Scotland Cancer Centre, Glasgow, UK ; School of Cancer Sciences, University of Glasgow, Glasgow, UK
Macias, Rocio I R; Experimental Hepatology and Drug Targeting (HEVEPHARM) Group, University of Salamanca, IBSAL, CIBERehd, Salamanca, Spain
Groot Koerkamp, Bas; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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