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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2019

01-09-2019 | Magnetic Resonance Cholangio Pancreatography | Hepatobiliary Tumors

Cholangiographic Tumor Classification for Simple Patient Selection Prior to Hepatopancreatoduodenectomy for Cholangiocarcinoma

Authors: Yoshitaka Toyoda, MD, Tomoki Ebata, MD, Takashi Mizuno, MD, Yukihiro Yokoyama, MD, Tsuyoshi Igami, MD, Junpei Yamaguchi, MD, Shunsuke Onoe, MD, Nobuyuki Watanabe, MD, Masato Nagino, MD

Published in: Annals of Surgical Oncology | Issue 9/2019

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Abstract

Background

Hepatopancreatoduodenectomy (HPD) is employed for patients with laterally advanced cholangiocarcinoma. However, the survival benefit of this extended approach remains controversial. The aim of this study is to identify a tumor feature benefiting from HPD from the standpoint of long-term survival.

Patients and Methods

Patients with cholangiocarcinoma who underwent HPD with curative intent between 2001 and 2017 were retrospectively analyzed. Tumors were radiologically classified by preoperative cholangiogram. Diffuse type was defined as significant tumor/stricture located from the hilar to intrapancreatic duct; localized type was defined as tumor otherwise. Univariable and multivariable analyses were performed to identify prognostic indicators.

Results

Of 100 study patients, 28 (28%) patients had diffuse tumor type, while the remaining 72 (72%) patients had localized tumors. The former group showed significantly longer lateral length (43 versus 22 mm, P < 0.001) and more frequent pancreatic invasion (50% versus 32%, P = 0.110), advanced T classification (64% versus 49%, P = 0.185), and nodal metastasis (57% versus 47%, P = 0.504), compared with the latter group. The survival for patients with diffuse tumor type was significantly worse than that for patients with localized tumor type, with 5-year survival rates of 59.0% versus 26.3%, respectively (P = 0.003). Multivariable analysis identified four independent factors deteriorating long-term survival: cholangiographic diffuse tumor (P = 0.021), higher age (P = 0.020), percutaneous biliary drainage (P = 0.007), and portal vein resection (P = 0.007).

Conclusions

Presurgical cholangiographic classification, diffuse or localized type, is a tumor-related factor closely associated with survival probability; therefore, it may be a useful feature for patient selection prior to HPD for cholangiocarcinoma.
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Literature
1.
Ebata T, Yokoyama Y, Igami T, et al. Review of hepatopancreatoduodenectomy for biliary cancer: an extended radical approach of Japanese origin. J Hepatobiliary Pancreat Sci. 2014;21:550–5.CrossRefPubMed
2.
Ebata T, Yokoyama Y, Igami T, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg. 2012;256:297–305.CrossRefPubMed
3.
Nimura Y, Hayakawa N, Kamiya J, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991;38:170–5.PubMed
4.
Tsukada K, Yoshida K, Aono T, et al. Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract. Br J Surg. 1994;81:108–10.CrossRefPubMed
5.
Ebata T, Nagino M, Nishio H, et al. Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg. 2007;14:131–5.CrossRefPubMed
6.
Aoki T, Sakamoto Y, Kohno Y, et al. Hepatopancreaticoduodenectomy for biliary cancer: strategies for near-zero operative mortality and acceptable long-term outcome. Ann Surg. 2018;267:332–7.CrossRefPubMed
7.
Otsubo T, Kobayashi S, Sano K, et al. Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons. J Hepatobiliary Pancreat Sci. 2017;24:252–61.CrossRefPubMed
8.
Tran TB, Dua MM, Spain DA, et al. Hepato-pancreatectomy: how morbid? Results from the national surgical quality improvement project. HPB (Oxford). 2015;17:763–9.CrossRefPubMedPubMedCentral
9.
Fernandes Ede S, Mello FT, Ribeiro-Filho J, et al. The largest Western experience with hepatopancreatoduodenectomy: lessons learned with 35 cases. Arq Bras Cir Dig. 2016;29:17–20.CrossRefPubMed
10.
Kaneoka Y, Yamaguchi A, Isogai M. Hepatopancreatoduodenectomy: its suitability for bile duct cancer versus gallbladder cancer. J Hepatobiliary Pancreat Surg. 2007;14:142–8.CrossRefPubMed
11.
Sakamoto Y, Nara S, Kishi Y, et al. Is extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer? Surgery. 2013;153:794–800.CrossRefPubMed
12.
Kawashima H, Itoh A, Ohno E, et al. Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: a retrospective study of efficacy and risk factors related to complications. Ann Surg. 2013;257:121–7.CrossRefPubMed
13.
Kawashima H, Itoh A, Ohno E, et al. Diagnostic and prognostic value of immunohistochemical expression of S100P and IMP3 in transpapillary biliary forceps biopsy samples of extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci. 2013;20:441–7.CrossRefPubMed
14.
Edgemen SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMed
15.
Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7.CrossRefPubMedPubMedCentral
16.
Nagino M, Nimura Y, Nishio H, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg. 2010;252:115–23.CrossRefPubMed
17.
Ebata T, Mizuno T, Yokoyama Y, et al. Surgical resection for Bismuth type IV perihilar cholangiocarcinoma. Br J Surg. 2018;105:829–38.CrossRefPubMed
18.
Mizuno T, Ebata T, Yokoyama Y, et al. Adjuvant gemcitabine monotherapy for resectable perihilar cholangiocarcinoma with lymph node involvement: a propensity score matching analysis. Surg Today. 2017;47:182–92.CrossRefPubMed
19.
Ebata T, Watanabe H, Ajioka Y, et al. Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg. 2002;89:1260–7.CrossRefPubMed
20.
Igami T, Nagino M, Oda K, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg. 2009;249:296–302.CrossRefPubMed
21.
Onoe S, Shimoyama Y, Ebata T, et al. Prognostic delineation of papillary cholangiocarcinoma based on the invasive proportion: a single-institution study with 184 patients. Surgery. 2014;155:280–91.CrossRefPubMed
22.
Sakamoto E, Nimura Y, Hayakawa N, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227:405–11.CrossRefPubMedPubMedCentral
23.
Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer. 2005;103:1210–6.CrossRefPubMed
24.
Wakai T, Shirai Y, Tsuchiya Y, et al. Combined major hepatectomy and pancreaticoduodenectomy for locally advanced biliary carcinoma: long-term results. World J Surg. 2008;32:1067–74.CrossRefPubMed
25.
Hirano S, Tanaka E, Tsuchikawa T, et al. Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2014;21:533–40.CrossRefPubMed
26.
Komaya K, Ebata T, Fukami Y, et al. Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma. J Gastroenterol. 2016;51:608–19.CrossRefPubMed
27.
Komaya K, Ebata T, Yokoyama Y, et al. Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage: a propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery. 2017;161:394–404.CrossRefPubMed
28.
Park MS, Kim TK, Kim KW, et al. Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 2004;233:234–40.CrossRefPubMed
29.
Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning. Abdom Imaging. 2008;33:444–51.CrossRefPubMed
30.
McGahan JP, Phillips HE, Cox KL. Sonography of the normal pediatric gallbladder and biliary tract. Radiology. 1982;144:873–5.CrossRefPubMed
31.
Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61:1657–69.CrossRefPubMed
32.
Noji T, Kondo S, Hirano S, et al. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer. Br J Surg. 2008;95:92–6.CrossRefPubMed
33.
Sugiura T, Nishio H, Nagino M, et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg. 2008;32:1478–84.CrossRefPubMed
34.
Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–81.CrossRefPubMed
35.
Bridgewater J, Lopes A, Wasan H, et al. Prognostic factors for progression-free and overall survival in advanced biliary tract cancer. Ann Oncol. 2016;27:134–40.CrossRefPubMed
36.
Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.CrossRefPubMed
Metadata
Title
Cholangiographic Tumor Classification for Simple Patient Selection Prior to Hepatopancreatoduodenectomy for Cholangiocarcinoma
Authors
Yoshitaka Toyoda, MD
Tomoki Ebata, MD
Takashi Mizuno, MD
Yukihiro Yokoyama, MD
Tsuyoshi Igami, MD
Junpei Yamaguchi, MD
Shunsuke Onoe, MD
Nobuyuki Watanabe, MD
Masato Nagino, MD
Publication date
01-09-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07457-x

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