Journal Article

Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group

Jarnagin, William R, Cescon Matteo, Andreou, A, Franken, L C, Bartsch, F, Benzing, C, de Savornin Lohman E, van Laarhoven S, Sparrelid Ernesto, Lang, Hauke, Guglielmi, Alfredo, Bagante Fabio, Schadde, E, Schmelzle Moritz, Erdmann, J I, Malagò, M, IJzermans J N M, Ravaioli, M, Pratschke Johann, Alikhanov Ruslan, Maithel, S K, Muiesan, P, Giovinazzo, G, Ligthart M A P, de Reuver P, Gomez-Gavara, C, Ratti, F, Jansson, H, van Vugt J L A, Efanov, M, Iacono Calogero, Isaac, J, Rolinger, J, Nadalin Silvio, van Gulik Thomas M, Heid, F, Damink S W M Olde, Campagnaro, T, Olthof, Pim B, Ruzzenente Andrea, Dejong, C H, Giglio, M C, Aldrighetti Luca, Buettner, S, Troisi, R, Malik, H Z, Serenari, M, Charco, R, Koerkamp Bas Groot, Quinn, L M, Capobianco, I

2021

Overview

BackgroundAlthough 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.MethodsUni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA.ResultsAmong 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).ConclusionsIn 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.

• Publisher: Springer Nature B.V
• Subject: Cholangiocarcinoma / Embolization / Hepatectomy / Medical prognosis / Metastases / Patients / Portal vein / Surgery / Survival