Outcomes after vascular resection during curative-intent resection for hilar cholangiocarcinoma: a multi-institution study from the US extrahepatic biliary malignancy consortium

• Type of Material: Article
• Authors: Gregory V. Schimizzi, Washington University; Linda X Jin, Washington University; Jesse T. Davidson, IV, Washington University; Bradley A. Krasnick, Washington University; Cecilia G. Ethun, Emory University; Timothy M. Pawlik, Johns Hopkins University Hospital; George Poultsides, Stanford University; Thuy Tran, Stanford University; Kamran Idrees, Vanderbilt University; Chelsea A. Isom, Vanderbilt University; Sharon M. Weber, Univ Wisconsin; Ahmed Salem, University of Wisconsin; William G. Hawkins, Washington University; Steven M. Strasberg, Washington University; Maria B. Doyle, Washington University; William C. Chapman, Washington University; Robert C.G. Martin, University of Louisville; Charles Scoggins, University of Louisville; Perry Shen, Wake Forest University; Harveshp D. Mogal, Wake Forest University; Carl Schmidt, Ohio State University; Eliza Beal, Ohio State University; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; Shishir Kumar Maithel, Emory University; Ryan C. Fields, Washington University; Richard Martin, Emory University
• Language: English
• Date: 2018-04-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 International Hepato-Pancreato-Biliary Association Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.hpb.2017.10.003
• Title of Journal or Parent Work: HPB
• ISSN: 1365-182X
• Volume: 20
• Issue: 4
• Start Page: 332
• End Page: 339
• Keywords: DIAGNOSIS; CANCER; Life Sciences & Biomedicine; Science & Technology; PORTAL-VEIN RESECTION; Gastroenterology & Hepatology; HEPATECTOMY; Surgery
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Background: Surgical resection is the cornerstone of curative-intent therapy for patients with hilar cholangiocarcinoma (HC). The role of vascular resection (VR) in the treatment of HC in western centres is not well defined. Methods: Utilizing data from the U.S. Extrahepatic Biliary Malignancy Consortium, patients were grouped into those who underwent resection for HC based on VR status: no VR, portal vein resection (PVR), or hepatic artery resection (HAR). Perioperative and long-term survival outcomes were analyzed. Results: Between 1998 and 2015, 201 patients underwent resection for HC, of which 31 (15%) underwent VR: 19 patients (9%) underwent PVR alone and 12 patients (6%) underwent HAR either with (n = 2) or without PVR (n = 10). Patients selected for VR tended to be younger with higher stage disease. Rates of postoperative complications and 30-day mortality were similar when stratified by vascular resection status. On multivariate analysis, receipt of PVR or HAR did not significantly affect OS or RFS. Conclusion: In a modern, multi-institutional cohort of patients undergoing curative-intent resection for HC, VR appears to be a safe procedure in a highly selected subset, although long-term survival outcomes appear equivalent. VR should be considered only in select patients based on tumor and patient characteristics.