Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections
Annals of Surgery,  Review Article

Nagino M et al. – The study aims to review the authors 34–year experience with 574 consecutive resections for perihilar cholangiocarcinoma and to evaluate the progress made in surgical treatment of this disease. Surgical treatment of perihilar cholangiocarcinoma has been evolving steadily, with expanded surgical indication, decreased mortality, and increased survival. Survival for R0 and pN0 patients was satisfactory, whereas survival for pN1 patients was still poor, suggesting that establishment of effective adjuvant chemotherapy is needed.

Methods

  • Between April 1977 and December 2010, a total of 754 consecutive patients with perihilar cholangiocarcinoma were treated, of whom 574 (76.1%) underwent resection.
  • The medical records of these resected patients were retrospectively reviewed.

Results

  • The incidence of major hepatectomies has increased, and limited resections, including central hepatectomies and bile duct resections, were rarely performed.
  • Combined vascular resection was being used more often.
  • Operative time has become shorter, and intraoperative blood loss has also decreased significantly.
  • Because of refinements in surgical techniques and perioperative management, morbidity decreased significantly but was still high, with a rate of 43.1% in the last 5 years.
  • Mortality rate has also decreased significantly (P < 0.001) from 11.1% (8/72) before 1990 to 1.4% (3/218) in the last 5 years.
  • The ratio of advanced disease defined as pStage IVA and IVB has increased significantly from 49.4% before 2000 to 61.4% after 2001.
  • The disease-specific survival for the 574 study patients (including all deaths) was 44.3% at year 3, 32.5% at year 5, and 19.9% at year 10.
  • The survival was significantly better in the later period of 2001 to 2010 than in the earlier period of 1977 to 2000 (38.1% vs 23.1% at year 5, P < 0.001).
  • For pM0, R0, and pN0 patients (n = 243), the survival in the later period was good with 67.1% at year 5, which was significantly better than that of the earlier period (P < 0.001).
  • For pM0, R0, and pN1 patients (n = 142), however, the survival in the later period was similar to that of the earlier period (22.1% vs 14.6% at year 5, P = 0.647).
  • Multivariate analysis revealed that lymph node metastasis was the strongest prognostic indicator.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Oncology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Oncology Articles

1 Long-term results of a randomised phase III trial of weekly versus three-weekly paclitaxel/platinum induction therapy followed by standard or extended three-weekly paclitaxel/platinum in European patients with advanced epithelial ovarian cancer European Journal of Cancer, August 6, 2014    Clinical Article

2 Metformin in chemotherapy-naive castration-resistant prostate cancer: A multicenter phase 2 trial (SAKK 08/09) Full Text European Urology, August 15, 2014    Free full text    Clinical Article

3 Screening for prostate cancer in the US? Reduce the harms and keep the benefit International Journal of Cancer, August 15, 2014    Clinical Article

4 Salt tea consumption and esophageal cancer, a possible role of alkaline beverages in esophageal carcinogenesis International Journal of Cancer, September 15, 2014    Clinical Article

5 Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): survival outcomes of a randomised, open-label, multicentre, phase 3 trial and their association with pathological complete response The Lancet Oncology, August 19, 2014    Clinical Article

6 Prognosis of synchronous bilateral breast cancer: a review and meta-analysis of observational studies Breast Cancer Research and Treatment, August 1, 2014    Evidence Based Medicine    Review Article

7 Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): A double-blind, randomised phase 3 trial The Lancet Oncology, September 25, 2014    Clinical Article

8 A prospective study of physical activity and breast cancer incidence in African American women Cancer Epidemiology, Biomarkers & Prevention, August 29, 2014

9 Survival follow-up and ipilimumab retreatment for patients with advanced melanoma who received ipilimumab in prior phase II studies Annals of Oncology, September 15, 2014    Clinical Article

10 Adolescent meat intake and breast cancer risk International Journal of Cancer, September 17, 2014    Clinical Article

11 Pathologic findings at risk-reducing salpingo-oophorectomy: Primary Results From Gynecologic Oncology Group Trial GOG-0199 Journal of Clinical Oncology, September 19, 2014    Clinical Article

12 Six versus fewer planned cycles of first-line platinum-based chemotherapy for non-small-cell lung cancer: A systematic review and meta-analysis of individual patient data The Lancet Oncology, September 24, 2014    Clinical Article

13 Smartphone breast applications - What's the evidence? The Breast, September 9, 2014    Clinical Article

14 Cumulative alkylating agent exposure and semen parameters in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study The Lancet Oncology, September 23, 2014    Clinical Article

15 Impact of trastuzumab treatment beyond disease progression for advanced/metastatic breast cancer on survival – Results from a prospective, observational study in Germany The Breast, July 24, 2014

16 Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system The American Journal of Surgery, September 3, 2014    Clinical Article

17 Observation after a positive sentinel lymph node biopsy in patients with melanoma Annals of Surgical Oncology, August 20, 2014    Clinical Article

18 Effects of pumpkin seed in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year, randomized, placebo-controlled granu study Urologia Internationalis, September 5, 2014    Clinical Article

19 FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial The Lancet Oncology, August 4, 2014    Clinical Article

20 Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study Journal of Clinical Oncology, July 17, 2014

Indexed Journals in Oncology: Journal of Clinical Oncology, Cancer Research, Annals Oncologymore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close