Abstract:
BACKGROUND:With cholangiocarcinoma, the only hope of a cure is resection. This study was undertaken to determine the impact of margin status, stage, tumor location, and adjuvant therapy on survival after resection of extrahepatic cholangiocarcinoma. METHODS:From 1985-2006, 91 patients underwent resections of cholangiocarcinomas. Margin status was codified as micro-/macroscopically negative, microscopically positive/ macroscopically negative, or micro-/macroscopically positive. Stage was determined using the AJCC classification (6th edition). Tumor location was classified as proximal, mid, or distal. Proximal tumors were resected by extrahepatic biliary resection with/without concomitant hepatic resection (n = 48), distal extrahepatic cholangiocarcinomas by pancreaticoduodenectomy (n = 35), and mid tumors by extrahepatic biliary resection alone (n = 8). Regression analysis and survival curve analysis were utilized. Data are presented as median, mean +/- standard deviation (SD). RESULTS:Overall survival after resection was 21 months, 38 +/- 46.0. Survival was not impacted by margin status (R0 20 months, 35 +/- 45.1 versus R1 32 months, 45 +/- 49.4). AJCC stage inversely correlated with survival (p = 0.004, Spearman regression analysis). Tumor location did not impact upon survival (p = 0.57, log-rank test). For proximal tumors, survival after biliary resection was significantly impacted by the need for concomitant hepatectomy (15 months, 27 +/- 31.4 versus 41 months, 67 +/- 17.1). Utilization of adjuvant therapy significantly improved survival (33 months, 56 +/- 63.1 versus 19 months, 33 +/- 40.0) (p = 0.046, Spearman regression). CONCLUSIONS:Survival after resection of extrahepatic cholangiocarcinoma is significantly impacted by AJCC stage, the use of adjuvant therapy, and in patients with proximal tumors, the need for concomitant hepatectomy. Margin status and tumor location do not impact survival. Cholangiocarcinomas should be aggressively resected irrespective of tumor location, even if resection might result in microscopically positive margins, and adjuvant therapy applied.
journal_name
Ann Surg Oncoljournal_title
Annals of surgical oncologyauthors
Hernandez J,Cowgill SM,Al-Saadi S,Villadolid D,Ross S,Kraemer E,Shapiro M,Mullinax J,Cooper J,Goldin S,Zervos E,Rosemurgy Adoi
10.1245/s10434-007-9756-2subject
Has Abstractpub_date
2008-03-01 00:00:00pages
807-14issue
3eissn
1068-9265issn
1534-4681journal_volume
15pub_type
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