1. Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group
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Ruzzenente, Andrea, Bagante, Fabio, Olthof, Pim B, Aldrighetti, Luca, Alikhanov, Ruslan, Cescon, Matteo, Koerkamp, Bas Groot, Jarnagin, William R, Nadalin, Silvio, Pratschke, Johann, Schmelzle, Moritz, Sparrelid, Ernesto, Lang, Hauke, Iacono, Calogero, van Gulik, Thomas M, Guglielmi, Alfredo, Andreou A, Bartsch F, Benzing C, Buettner S, Campagnaro T, Capobianco I, Charco R, de Reuver P, de Savornin, Lohman E, Nijmegen, Dejong CHC, Efanov M, Erdmann JI, Franken LC, Giovinazzo G, Giglio MC, Gomez-Gavara C, Heid F, IJzermans JNM, Isaac J, Jansson H, Ligthart MAP, Maithel SK, Malago` M. Malik HZ, Muiesan P, Olde Damink SWM, Quinn LM, Ratti F, Ravaioli M, Rolinger J, Schadde E, Serenari M, Troisi R, van Laarhoven S, van Vugt JLA, Faculteit Medische Wetenschappen/UMCG, Surgery, Ruzzenente, Andrea, Bagante, Fabio, Olthof, Pim B, Aldrighetti, Luca, Alikhanov, Ruslan, Cescon, Matteo, Koerkamp, Bas Groot, Jarnagin, William R, Nadalin, Silvio, Pratschke, Johann, Schmelzle, Moritz, Sparrelid, Ernesto, Lang, Hauke, Iacono, Calogero, van Gulik, Thomas M, Guglielmi, Alfredo, Andreou, A, Bartsch, F, Benzing, C, Buettner, S, Campagnaro, T, Capobianco, I, Charco, R, de Reuver, P, De, Savornin, Lohman, E, Nijmegen, Dejong, Chc, Efanov, M, Erdmann, Ji, Franken, Lc, Giovinazzo, G, Giglio, Mc, Gomez-Gavara, C, Heid, F, Ijzermans, Jnm, Isaac, J, Jansson, H, Ligthart, Map, Maithel, Sk, Malago` M., Malik HZ, Muiesan, P, Olde Damink, Swm, Quinn, Lm, Ratti, F, Ravaioli, M, Rolinger, J, Schadde, E, Serenari, M, Troisi, R, van Laarhoven, S, van Vugt, Jla, Ruzzenente, A., Bagante, F., Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Koerkamp, B. G., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Iacono, C., van Gulik, T. M., Guglielmi, A., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Campagnaro, T., Capobianco, I., Charco, R., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Giovinazzo, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Isaac, J., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Damink, S. W. M. O., Quinn, L. M., Ratti, F., Ravaioli, M., Rolinger, J., Schadde, E., Serenari, M., Troisi, R., van Laarhoven, S., van Vugt, J. L. A., CCA - Cancer Treatment and Quality of Life, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
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medicine.medical_specialty ,medicine.medical_treatment ,Perineural invasion ,Metastasis ,Cholangiocarcinoma ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,Surgical oncology ,Medicine ,Hepatectomy ,Humans ,Perihilar Cholangiocarcinoma ,Contraindication ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Surgery ,Oncology ,Bile Duct Neoplasms ,Cohort ,business ,Bismuth ,Klatskin Tumor - Abstract
Background Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. Methods Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. Results Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). Conclusions In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.
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- 2020