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01-03-2008 | Hepatic and Pancreatic Tumors

An Aggressive Approach to Extrahepatic Cholangiocarcinomas Is Warranted: Margin Status Does Not Impact Survival after Resection

Authors: Jonathan Hernandez, MD, Sarah M. Cowgill, MD, Sam Al-Saadi, MD, Desiree Villadolid, MPH, Sharona Ross, MD, Emily Kraemer, Mark Shapiro, John Mullinax, BS, Jennifer Cooper, BS, Steven Goldin, MD, PhD, Emmanuel Zervos, MD, Alexander Rosemurgy, MD

Published in: Annals of Surgical Oncology | Issue 3/2008

Abstract

Background

With cholangiocarcinoma, the only hope of a cure is resection. This study was undertaken to determine the impact of margin status, stage, tumor location, and adjuvant therapy on survival after resection of extrahepatic cholangiocarcinoma.

Methods

From 1985–2006, 91 patients underwent resections of cholangiocarcinomas. Margin status was codified as micro-/macroscopically negative, microscopically positive/ macroscopically negative, or micro-/macroscopically positive. Stage was determined using the AJCC classification (6^th edition). Tumor location was classified as proximal, mid, or distal. Proximal tumors were resected by extrahepatic biliary resection with/without concomitant hepatic resection (n = 48), distal extrahepatic cholangiocarcinomas by pancreaticoduodenectomy (n = 35), and mid tumors by extrahepatic biliary resection alone (n = 8). Regression analysis and survival curve analysis were utilized. Data are presented as median, mean ± standard deviation (SD).

Results

Overall survival after resection was 21 months, 38 ± 46.0. Survival was not impacted by margin status (R0 20 months, 35 ± 45.1 versus R1 32 months, 45 ± 49.4). AJCC stage inversely correlated with survival (p = 0.004, Spearman regression analysis). Tumor location did not impact upon survival (p = 0.57, log-rank test). For proximal tumors, survival after biliary resection was significantly impacted by the need for concomitant hepatectomy (15 months, 27 ± 31.4 versus 41 months, 67 ± 17.1). Utilization of adjuvant therapy significantly improved survival (33 months, 56 ± 63.1 versus 19 months, 33 ± 40.0) (p = 0.046, Spearman regression).

Conclusions

Survival after resection of extrahepatic cholangiocarcinoma is significantly impacted by AJCC stage, the use of adjuvant therapy, and in patients with proximal tumors, the need for concomitant hepatectomy. Margin status and tumor location do not impact survival. Cholangiocarcinomas should be aggressively resected irrespective of tumor location, even if resection might result in microscopically positive margins, and adjuvant therapy applied.

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Title: An Aggressive Approach to Extrahepatic Cholangiocarcinomas Is Warranted: Margin Status Does Not Impact Survival after Resection
Authors: Jonathan Hernandez, MD
Sarah M. Cowgill, MD
Sam Al-Saadi, MD
Desiree Villadolid, MPH
Sharona Ross, MD
Emily Kraemer
Mark Shapiro
John Mullinax, BS
Jennifer Cooper, BS
Steven Goldin, MD, PhD
Emmanuel Zervos, MD
Alexander Rosemurgy, MD
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9756-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

An Aggressive Approach to Extrahepatic Cholangiocarcinomas Is Warranted: Margin Status Does Not Impact Survival after Resection

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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