1. Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma.
- Author
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Geers J, Jaekers J, Topal H, Aerts R, Vandoren C, Vanden Boer G, and Topal B
- Subjects
- Humans, Kaplan-Meier Estimate, Neoplasm Staging, Prognosis, Retrospective Studies, Treatment Outcome, Bile Duct Neoplasms pathology, Bile Duct Neoplasms surgery, Cholangiocarcinoma pathology, Cholangiocarcinoma surgery, Klatskin Tumor pathology, Klatskin Tumor surgery
- Abstract
Background: Several clinicopathological predictors of survival after curative surgery for perihilar cholangiocarcinoma (pCCA) have been identified; however, conflicting reports remain. The aim was to analyse clinical and oncological outcomes after curative resection of pCCA and to determine prognostic factors., Methods: Eighty-eight consecutive patients with pCCA underwent surgery with curative intent between 1998 and 2017. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Twenty-one prognostic factors were evaluated using multivariate Cox regression models., Results: Postoperative complications were observed in 73 (83%) patients of which 41 (47%) were severe complications (therapy-oriented severity grading system (TOSGS) grade > 2), including a 90-day mortality of 9% (n = 8). Overall survival (OS) and disease-free survival (DFS) rates at 5 and 10 years after surgery were 33% and 19%, and 37% and 30%, respectively. Independent predictors of OS were locoregional lymph node metastasis (LNM) (risk ratio (RR) 2.12, confidence interval (CI) 1.19-3.81, p = 0.011), patient American Society of Anesthesiologists (ASA) physical status classification system > 2 (RR 2.10, CI 1.03-4.26, p = 0.043), and depth of tumour penetration (pT) > 2 (RR 2.58, CI 1.03-6.30, p = 0.043). The presence of locoregional LNM (RR 2.95, CI 1.51-5.90, p = 0.002) and caudate lobe resection (RR 2.19, CI 1.01-5.14, p = 0.048) were found as independent predictors of DFS., Conclusions: Curative surgery for pCCA carries high risks with poor long-term survival. Locoregional LNM was the only predictor for both OS and DFS.
- Published
- 2020
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