TY - JOUR
T1 - The blumgart preoperative staging system for hilar cholangiocarcinoma
T2 - Analysis of resectability and outcomes in 380 patients
AU - Matsuo, Kenichi
AU - Rocha, Flavio G.
AU - Ito, Kaori
AU - D'Angelica, Michael I.
AU - Allen, Peter J.
AU - Fong, Yuman
AU - Dematteo, Ronald P.
AU - Gonen, Mithat
AU - Endo, Itaru
AU - Jarnagin, William R.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/9
Y1 - 2012/9
N2 - Complete resection of hilar cholangiocarcinoma (HCCA) is a critical determinant of long-term survival. This study validates a previously reported preoperative clinical T staging system for determining resectability of HCCA. Consecutive patients with confirmed HCCA treated over an 18-year period were included. Patient demographics, preoperative imaging studies, resection type, margin status, lymph node status, histopathologic findings, morbidity, and outcomes were entered prospectively and analyzed retrospectively; changes in these variables over time were assessed. All patients were placed into 1 of 3 stages based on the extent of ductal involvement by tumor, portal vein compromise, or lobar atrophy. From March 1991 through December 2008, 380 patients were evaluated. Eighty-five patients had unresectable disease; 295 patients underwent exploration with curative intent. One hundred fifty-seven patients underwent resection: 129 (82.2%) had a concomitant hepatic resection and 120 (76.4%) had an R0 resection. Of the 32 actual 5-year survivors (120 at risk), 30 patients (93.8%) had a concomitant hepatic resection. In patients who underwent an R0 resection, concomitant partial hepatectomy, well-differentiated histology, and negative lymph nodes were independent predictors of long-term survival. In the 376 patients whose disease could be staged, the preoperative clinical T staging system predicted resectability (p < 0.001), metastatic disease (p < 0.001), and R0 resection (p = 0.007). The preoperative clinical T staging system of Blumgart, defined by the radial and longitudinal tumor extent, accurately predicts resectability of HCCA. The full outcomes benefit of resection is realized only if a concomitant partial hepatectomy is performed.
AB - Complete resection of hilar cholangiocarcinoma (HCCA) is a critical determinant of long-term survival. This study validates a previously reported preoperative clinical T staging system for determining resectability of HCCA. Consecutive patients with confirmed HCCA treated over an 18-year period were included. Patient demographics, preoperative imaging studies, resection type, margin status, lymph node status, histopathologic findings, morbidity, and outcomes were entered prospectively and analyzed retrospectively; changes in these variables over time were assessed. All patients were placed into 1 of 3 stages based on the extent of ductal involvement by tumor, portal vein compromise, or lobar atrophy. From March 1991 through December 2008, 380 patients were evaluated. Eighty-five patients had unresectable disease; 295 patients underwent exploration with curative intent. One hundred fifty-seven patients underwent resection: 129 (82.2%) had a concomitant hepatic resection and 120 (76.4%) had an R0 resection. Of the 32 actual 5-year survivors (120 at risk), 30 patients (93.8%) had a concomitant hepatic resection. In patients who underwent an R0 resection, concomitant partial hepatectomy, well-differentiated histology, and negative lymph nodes were independent predictors of long-term survival. In the 376 patients whose disease could be staged, the preoperative clinical T staging system predicted resectability (p < 0.001), metastatic disease (p < 0.001), and R0 resection (p = 0.007). The preoperative clinical T staging system of Blumgart, defined by the radial and longitudinal tumor extent, accurately predicts resectability of HCCA. The full outcomes benefit of resection is realized only if a concomitant partial hepatectomy is performed.
KW - AJCC
KW - American Joint Committee on Cancer
KW - DSS
KW - FDG-PET
KW - HCCA
KW - MDCT
KW - MRCP
KW - MSKCC
KW - Memorial Sloan-Kettering Cancer Center
KW - disease-specific survival
KW - hilar cholangiocarcinoma
KW - magnetic resonance cholangiopancreatography
KW - multidetector-row computed tomography
KW - positron emission tomography with [(18) F] fluoro-2-deoxy-D-glucose
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U2 - 10.1016/j.jamcollsurg.2012.05.025
DO - 10.1016/j.jamcollsurg.2012.05.025
M3 - Article
C2 - 22749003
AN - SCOPUS:84865233568
SN - 1072-7515
VL - 215
SP - 343
EP - 355
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
ER -