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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AU - Yamamoto, Junji

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