Surgical management of infrahilar/suprapancreatic cholangiocarcinoma

An analysis of the surgical procedures, Surgical margins, and survivals of 77 patients

Yoshihiro Sakamoto, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Hidenori Ojima, Tsuyoshi Sano, Junji Yamamoto, Tomoo Kosuge

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Optical surgical management of infrahilar/suprapancreatic cholangiocarcinoma remains controversial. Methods: Between 1988 and 2006, 77 patients with infrahilar/suprapancreatic cholangiocarcinoma underwent curative surgical resections following our intention-to-treat strategy. The clinicopathological factors affecting survival were evaluated using univariate and multivariate analyses with regard to the surgical procedures and surgical margins. Results: The surgical procedure included extrahepatic bile duct resection alone (EHBD; n = 17), major hepatectomy combined with extrahepatic bile duct resection (MHx; n = 26), pancreaticoduodenectomy (PD; n = 28), and MHx and concomitant PD (HPD; n = 6). Performance of MHx and/or PD in addition to EHBD increased surgical morbidity (p = 0.001). Among patients undergoing the four surgical procedures (EHBD, MHx, PD, and HPD), no significant difference was found in the incidence of positive overall surgical margins (53%, 65%, 46%, and 67%, p = 0.51) or long-term survivals (median survival time, 51, 27, 41, and 22 months, p = 0.60). A multivariate analysis revealed that perineural invasion (95% confidence interval, 1.1-12.3, p = 0.009), nodal metastasis (1.6-6.8, p = 0.001), and blood transfusion (1.1-3.9, p = 0.02) were independent predictors of a poor outcome. Perineural invasion was associated with positive radial margins (p = 0.045) and submucosal ductal infiltration (p = 0.03). Conclusion: Perineural invasion, rather than the type of surgical procedure, had a significant impact on surgical curability and survival of patients with infrahilar/suprapancreatic cholangiocarcinoma treated according to our intention-to-treat strategy.

Original languageEnglish
Pages (from-to)335-343
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number2
DOIs
Publication statusPublished - 2010 Feb
Externally publishedYes

Fingerprint

Cholangiocarcinoma
Survival
Extrahepatic Bile Ducts
Multivariate Analysis
Pancreaticoduodenectomy
Hepatectomy
Blood Transfusion
Margins of Excision
Confidence Intervals
Neoplasm Metastasis
Morbidity
Incidence

Keywords

  • Cholangiocarcinoma
  • Major hepatectomy
  • Pancreaticoduodenectomy
  • Perineural invasion
  • Upper and middle

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology
  • Medicine(all)

Cite this

Surgical management of infrahilar/suprapancreatic cholangiocarcinoma : An analysis of the surgical procedures, Surgical margins, and survivals of 77 patients. / Sakamoto, Yoshihiro; Shimada, Kazuaki; Nara, Satoshi; Esaki, Minoru; Ojima, Hidenori; Sano, Tsuyoshi; Yamamoto, Junji; Kosuge, Tomoo.

In: Journal of Gastrointestinal Surgery, Vol. 14, No. 2, 02.2010, p. 335-343.

Research output: Contribution to journalArticle

Sakamoto, Yoshihiro ; Shimada, Kazuaki ; Nara, Satoshi ; Esaki, Minoru ; Ojima, Hidenori ; Sano, Tsuyoshi ; Yamamoto, Junji ; Kosuge, Tomoo. / Surgical management of infrahilar/suprapancreatic cholangiocarcinoma : An analysis of the surgical procedures, Surgical margins, and survivals of 77 patients. In: Journal of Gastrointestinal Surgery. 2010 ; Vol. 14, No. 2. pp. 335-343.
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abstract = "Background: Optical surgical management of infrahilar/suprapancreatic cholangiocarcinoma remains controversial. Methods: Between 1988 and 2006, 77 patients with infrahilar/suprapancreatic cholangiocarcinoma underwent curative surgical resections following our intention-to-treat strategy. The clinicopathological factors affecting survival were evaluated using univariate and multivariate analyses with regard to the surgical procedures and surgical margins. Results: The surgical procedure included extrahepatic bile duct resection alone (EHBD; n = 17), major hepatectomy combined with extrahepatic bile duct resection (MHx; n = 26), pancreaticoduodenectomy (PD; n = 28), and MHx and concomitant PD (HPD; n = 6). Performance of MHx and/or PD in addition to EHBD increased surgical morbidity (p = 0.001). Among patients undergoing the four surgical procedures (EHBD, MHx, PD, and HPD), no significant difference was found in the incidence of positive overall surgical margins (53{\%}, 65{\%}, 46{\%}, and 67{\%}, p = 0.51) or long-term survivals (median survival time, 51, 27, 41, and 22 months, p = 0.60). A multivariate analysis revealed that perineural invasion (95{\%} confidence interval, 1.1-12.3, p = 0.009), nodal metastasis (1.6-6.8, p = 0.001), and blood transfusion (1.1-3.9, p = 0.02) were independent predictors of a poor outcome. Perineural invasion was associated with positive radial margins (p = 0.045) and submucosal ductal infiltration (p = 0.03). Conclusion: Perineural invasion, rather than the type of surgical procedure, had a significant impact on surgical curability and survival of patients with infrahilar/suprapancreatic cholangiocarcinoma treated according to our intention-to-treat strategy.",
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