Overall survival peri-hilar cholangiocarcinoma: R1 resection with curative intent compared to primary endoscopic therapy

Authors

  • Suzanne C. Schiffman MD,

    1. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
    2. James Graham Brown Cancer Center, Louisville, KY
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  • Nathaniel P. Reuter MD,

    1. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
    2. James Graham Brown Cancer Center, Louisville, KY
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  • Kelly M. McMasters MD, PhD,

    1. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
    2. James Graham Brown Cancer Center, Louisville, KY
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  • Charles R. Scoggins MD, MBA,

    1. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
    2. James Graham Brown Cancer Center, Louisville, KY
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  • Robert C.G. Martin MD, PhD

    Corresponding author
    1. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
    2. James Graham Brown Cancer Center, Louisville, KY
    • Professor of Surgery, Director, Division of Surgical Oncology, Department of Surgery, University of Louisville, Norton Healthcare Pavilion, 315 East Broadway, Suite 303, Louisville, KY 40202.===

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  • Peri-hilar cholangiocarcinoma poses a significant therapeutic challenge secondary to the anatomic location and the underlying tumor biology. We sought to determine if patients with proximal cholangiocarcinoma who undergo an R1 resection (with curative intent) will have an improved survival compared to patients who are not resected and are managed with optimal endoscopic and medical therapy.

Abstract

Background and Objectives

Patients with peri-hilar cholangiocarcinoma who undergo R1 resection with curative intent will have an improved survival compared to patients who were not resected.

Methods

Review of a prospective hepatobiliary database identified 130 patients. Survival was compared using the log-rank test.

Results

Seventy-nine patients (61%) were resected while 51 (49%) patients were not. Forty-two patients (54%) had an R0 resection. There was no difference in mean age (69 vs. 67; P = 0.8), BMI (27.8 vs. 27.9; P = 1.0), gender (73% vs. 43% male; P = 0.1), presence of jaundice (77% vs. 64%; P = 0.5), vascular involvement on pre operative imaging (77% vs. 64%; P = 0.5), stent (73.1% vs. 64.3%; P = 0.72), and lobar atrophy (27% vs. 7%, P = 0.2) in the resected versus non-resected patients. All patients underwent chemotherapy and/or radiation therapy. After a median follow up of 35.6 months the median OSl for all peri-hilar patients was 16.2 months (95% CI = 11.2–23.4). The median OS for resected patients was 18.9 months (95% CI = 12.5–24.7) versus 5.0 months (95% CI = 0–6.9) for patients not resected (P < 0.001). The only pre-operative predictor of OS was resection (P = 0.041). Vascular invasion, lobar atrophy, and stent placement were not statistically significant predictors.

Conclusion

Overall survival is improved in patients undergoing R1 resection and multi-modality therapy compared to patients not resected. J. Surg. Oncol. 2012; 105:91–96. © 2011 Wiley Periodicals, Inc.

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