Faculty Collaboration Database

Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers: Outcome analysis and prognostic factors. Surgery 2017 Sep;162(3):500-514

Date

05/30/2017

Pubmed ID

28551378

DOI

10.1016/j.surg.2017.03.017

Scopus ID

2-s2.0-85019605405 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

BACKGROUND: Extensive resection for hilar cholangiocarcinoma is the most effective treatment, but high morbidity and poor prognosis remain concerns. Previous data have shown marked differences in outcomes between comparable Eastern and Western centers. We compared the outcomes of the management for hilar cholangiocarcinoma at one Japanese and one British institution with comparable experience.

METHODS: Of 298 consecutive patients with hilar cholangiocarcinoma evaluated at Hirosaki University Hospital, Japan and St. James's University Hospital, Leeds, UK, 183 underwent radical resection. Clinicopathologic variables and postoperative outcomes were compared.

RESULTS: Significant differences were not observed between the Hirosaki and Leeds cohorts in overall outcomes despite several differences in the patient characteristics. Although there was a difference in 90-day mortality (2.5% vs 13.6%, respectively), disease-specific 5-year survival rates were 32.8% and 31.9%, respectively (P = .767). Multivariate analysis identified trisectionectomy (odds ratio = 2.32; P = .010), combined pancreatoduodenectomy (odds ratio = 7.88; P = .010), and perioperative blood transfusion (odds ratio = 1.88; P = .045) were associated with postoperative major complications, while preoperative biliary drainage associated with postoperative major complications, while preoperative biliary drainage (risk ratio = 2.21; P = .018), perioperative blood transfusion (risk ratio = 1.58; P = .029), lymph node metastasis (risk ratio = 2.00; P = .002), moderate/poorly differentiated tumor (risk ratio = 1.72; P = .029), microvascular invasion (risk ratio = 1.63; P = .046), and R1 resection (risk ratio = 1.90; P = .005) were risk factors for poor survival.

CONCLUSION: Disease-specific survival and prognostic factors were similar in both centers. Meticulous operative technique to avoid perioperative blood transfusion may improve long-term survival.

Author List

Kimura N, Young AL, Toyoki Y, Wyatt JI, Toogood GJ, Hidalgo E, Prasad KR, Kudo D, Ishido K, Hakamada K, Lodge JPA

Author

Kondragunta Rajendra Prasad MBBS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Aged
Bile Duct Neoplasms
Cohort Studies
Disease-Free Survival
Female
Hepatectomy
Hospitals, University
Humans
Japan
Kaplan-Meier Estimate
Klatskin Tumor
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Staging
Postoperative Complications
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Sex Factors
Survival Analysis
Treatment Outcome
United Kingdom