Objective To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. Design Retrospective multicenter study including 17 Italian hepatobiliary surgery units. Patients A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. Main Outcome Measures Postoperative mortality, morbidity, overall survival, and disease-free survival. Results Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (right or right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P = .03 and P = .006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P = .05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. Conclusions Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.
IMPROVEMENT IN PERIOPERATIVE AND LONG-TERMOUTCOME AFTER SURGICAL TREATMENT HILAR CHOLANGIOCARCINOMA.Results of an Italian Multicenter Analysis of 440 Patients / Gennaro, Nuzzo; Felice, Giuliante; Francesco, Ardito; Ivo, Giovannini; Luca, Aldrighetti; Giulio, Belli; Fabrizio, Bresadola; Fulvio, Calise; DALLA VALLE, Raffaele; Davide F., D’Amico; Leandro, Gennari; Stefano M., Giulini; Alfredo, Guglielmi; Elio, Jovine; Riccardo, Pellicci; Heinrich, Pernthaler; Antonio D., Pinna; Stefano, Puleo; Guido, Torzilli; Lorenzo, Capussotti. - In: ARCHIVES OF SURGERY. - ISSN 0004-0010. - 147:(2012), pp. 26-34. [10.1001/archsurg.2011.771]
IMPROVEMENT IN PERIOPERATIVE AND LONG-TERMOUTCOME AFTER SURGICAL TREATMENT HILAR CHOLANGIOCARCINOMA.Results of an Italian Multicenter Analysis of 440 Patients
DALLA VALLE, Raffaele;
2012-01-01
Abstract
Objective To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. Design Retrospective multicenter study including 17 Italian hepatobiliary surgery units. Patients A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. Main Outcome Measures Postoperative mortality, morbidity, overall survival, and disease-free survival. Results Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (right or right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P = .03 and P = .006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P = .05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. Conclusions Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
