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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2016

Open Access 01-12-2016 | Hepatobiliary Tumors

Development of a Risk Score to Predict Detection of Metastasized or Locally Advanced Perihilar Cholangiocarcinoma at Staging Laparoscopy

Authors: Robert J. S. Coelen, MD, Anthony T. Ruys, MD, PhD, Jimme K. Wiggers, MD, PhD, Chung Y. Nio, MD, Joanne Verheij, MD, PhD, Dirk J. Gouma, MD, PhD, Marc G. H. Besselink, MD, PhD, Olivier R. C. Busch, MD, PhD, Thomas M. van Gulik, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 5/2016

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Abstract

Background

Nearly half of patients with perihilar cholangiocarcinoma (PHC) have incurable tumors at laparotomy. Staging laparoscopy (SL) potentially detects metastases or locally advanced disease, thereby avoiding unnecessary laparotomy. However, the diagnostic yield of SL has decreased with improved imaging in recent years.

Objective

The aim of this study was to identify predictors for detecting metastasized or locally advanced PHC at SL and to develop a risk score to select patients who may benefit most from this procedure.

Methods

Data of patients with potentially resectable PHC who underwent SL between 2000 and 2015 in our center were retrospectively analyzed. Multivariable logistic regression analysis was used to identify independent predictors and to develop a preoperative risk score.

Results

Unresectable PHC was detected in 41 of 273 patients undergoing SL (yield 15 %). Overall sensitivity of SL was 30 %, with highest sensitivity for detecting peritoneal metastases (73 %). Preoperative imaging factors that were independently associated with unresectability at SL were tumor size ≥4.5 cm, bilateral portal vein involvement, suspected lymph node metastases, and suspected (extra)hepatic metastases on imaging without the possibility of diagnosis by percutaneous- or endoscopic ultrasound-guided biopsy. The derived preoperative risk score showed good discrimination to predict unresectability (area under the curve 0.77, 95 % confidence interval 0.68–0.86) and identified three subgroups with a predicted low-risk of 7 % (N = 203 patients), intermediate-risk of 21 % (N = 39), and high-risk of 58 % (N = 31).

Conclusions

A selective approach for SL in PHC is recommended since the overall yield is low. The proposed preoperative risk score is useful in selecting patients for SL.
Appendix
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Metadata
Title
Development of a Risk Score to Predict Detection of Metastasized or Locally Advanced Perihilar Cholangiocarcinoma at Staging Laparoscopy
Authors
Robert J. S. Coelen, MD
Anthony T. Ruys, MD, PhD
Jimme K. Wiggers, MD, PhD
Chung Y. Nio, MD
Joanne Verheij, MD, PhD
Dirk J. Gouma, MD, PhD
Marc G. H. Besselink, MD, PhD
Olivier R. C. Busch, MD, PhD
Thomas M. van Gulik, MD, PhD
Publication date
01-12-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue Special Issue 5/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5531-6

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