Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma
Background Although bile duct resection (BDR) in addition to pancreaticoduodenectomy (PD) is considered a surgical approach in patients with middle-third cholangiocarcinoma (MCC), available prognostic information after BDR remains very limited. The aim of this study was to reappraise BDR from the vi...
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| Veröffentlicht in: | Annals of surgical oncology 2021-04, Vol.28 (4), p.1990-1999 |
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| container_title | Annals of surgical oncology |
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| creator | Jikei, Kosuke Ebata, Tomoki Mizuno, Takashi Kyokane, Takanori Matsubara, Hideo Yokoyama, Shinya Kato, Kenji Suzumura, Kiyoshi Hashimoto, Mizuo Kawai, Satoru Nagino, Masato |
| description | Background
Although bile duct resection (BDR) in addition to pancreaticoduodenectomy (PD) is considered a surgical approach in patients with middle-third cholangiocarcinoma (MCC), available prognostic information after BDR remains very limited. The aim of this study was to reappraise BDR from the viewpoint of surgical oncology.
Methods
Patients who underwent BDR or PD for MCC between 2001 and 2010 at 32 Japanese hospitals were included. Clinicopathological factors were retrospectively compared according to surgical procedure to identify a subset cohort who benefited most from BDR.
Results
During the study, 92 patients underwent BDR (
n
= 38) or PD (
n
= 54). BDR was characterized by a shorter operation time, less blood loss, less frequent complications, and lower mortality, than PD. The incidence of positive surgical margins was 26.3% versus 5.6% (
P
= 0.007). The survival rate after BDR was significantly worse than that after PD: 38.8% versus 54.8% at 5 years (
P
= 0.035), and BDR was independently associated with deteriorated survival [hazard ratio (HR), 1.76;
P
= 0.023] by multivariable analysis. In the BDR group, tumor length |
| doi_str_mv | 10.1245/s10434-020-09157-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2444876637</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2444876637</sourcerecordid><originalsourceid>FETCH-LOGICAL-c459t-e924b108fedd2f11e1ae315302925c56aaa056d43824e9a70edd91755ec7d0793</originalsourceid><addsrcrecordid>eNp9kD1PwzAURS0EolD4AwwoEgtLwJ9xPEL5lIqKUJkt13lpXaVxsZOBf4-hBSQGJlt-511fHYROCL4glIvLSDBnPMcU51gRIXO2gw6ISE-8KMluuuOizBUtxAAdxrjEmEiGxT4aMKoKzBQ9QM-T1vrGz53NXsCs18G4aJrM19m1ayC76W2XBhFs53yb1T5kT66qGsinCxeqbLTwjWnnzlsTrGv9yhyhvdo0EY635xC93t1ORw_5eHL_OLoa55YL1eWgKJ8RXNZQVbQmBIgBlrpjqqiwojDGYFFUnJWUgzISJ04RKQRYWWGp2BCdb3LXwb_1EDu9ctFCk-qA76OmnPNSFgWTCT37gy59H9rULlGqlErSkiaKbigbfIwBar0ObmXCuyZYf_rWG986-dZfvjVLS6fb6H62gupn5VtwAtgGiGnUziH8_v1P7AdSnImv</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2498797282</pqid></control><display><type>article</type><title>Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Jikei, Kosuke ; Ebata, Tomoki ; Mizuno, Takashi ; Kyokane, Takanori ; Matsubara, Hideo ; Yokoyama, Shinya ; Kato, Kenji ; Suzumura, Kiyoshi ; Hashimoto, Mizuo ; Kawai, Satoru ; Nagino, Masato</creator><creatorcontrib>Jikei, Kosuke ; Ebata, Tomoki ; Mizuno, Takashi ; Kyokane, Takanori ; Matsubara, Hideo ; Yokoyama, Shinya ; Kato, Kenji ; Suzumura, Kiyoshi ; Hashimoto, Mizuo ; Kawai, Satoru ; Nagino, Masato ; Nagoya Surgical Oncology Group ; the Nagoya Surgical Oncology Group</creatorcontrib><description>Background
Although bile duct resection (BDR) in addition to pancreaticoduodenectomy (PD) is considered a surgical approach in patients with middle-third cholangiocarcinoma (MCC), available prognostic information after BDR remains very limited. The aim of this study was to reappraise BDR from the viewpoint of surgical oncology.
Methods
Patients who underwent BDR or PD for MCC between 2001 and 2010 at 32 Japanese hospitals were included. Clinicopathological factors were retrospectively compared according to surgical procedure to identify a subset cohort who benefited most from BDR.
Results
During the study, 92 patients underwent BDR (
n
= 38) or PD (
n
= 54). BDR was characterized by a shorter operation time, less blood loss, less frequent complications, and lower mortality, than PD. The incidence of positive surgical margins was 26.3% versus 5.6% (
P
= 0.007). The survival rate after BDR was significantly worse than that after PD: 38.8% versus 54.8% at 5 years (
P
= 0.035), and BDR was independently associated with deteriorated survival [hazard ratio (HR), 1.76;
P
= 0.023] by multivariable analysis. In the BDR group, tumor length < 15 mm (HR, 3.38;
P
= 0.017) and ductal margin length ≥ 10 mm (HR, 2.54;
P
= 0.018) were independent positive prognostic factors. Stratified by these two favorable factors, the 5-year survival rate was 63.0% in patients with 1/2 factors and 6.7% in those with 0 factors (
P
< 0.001).
Conclusion
In patients with MCC, BDR provided a better short-term and a worse long-term outcome than PD. However, patient selection using tumor length and ductal margin length may allow a favorable survival probability even after BDR.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-020-09157-3</identifier><identifier>PMID: 32960392</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Bile ; Bile Duct Neoplasms - surgery ; Bile ducts ; Bile Ducts - surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; Cholangiocarcinoma - surgery ; Hepatectomy ; Hepatobiliary Tumors ; Humans ; Medical prognosis ; Medicine ; Medicine & Public Health ; Oncology ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies ; Surgery ; Surgical Oncology ; Survival ; Treatment Outcome</subject><ispartof>Annals of surgical oncology, 2021-04, Vol.28 (4), p.1990-1999</ispartof><rights>Society of Surgical Oncology 2020</rights><rights>Society of Surgical Oncology 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-e924b108fedd2f11e1ae315302925c56aaa056d43824e9a70edd91755ec7d0793</citedby><cites>FETCH-LOGICAL-c459t-e924b108fedd2f11e1ae315302925c56aaa056d43824e9a70edd91755ec7d0793</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-020-09157-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-020-09157-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32960392$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jikei, Kosuke</creatorcontrib><creatorcontrib>Ebata, Tomoki</creatorcontrib><creatorcontrib>Mizuno, Takashi</creatorcontrib><creatorcontrib>Kyokane, Takanori</creatorcontrib><creatorcontrib>Matsubara, Hideo</creatorcontrib><creatorcontrib>Yokoyama, Shinya</creatorcontrib><creatorcontrib>Kato, Kenji</creatorcontrib><creatorcontrib>Suzumura, Kiyoshi</creatorcontrib><creatorcontrib>Hashimoto, Mizuo</creatorcontrib><creatorcontrib>Kawai, Satoru</creatorcontrib><creatorcontrib>Nagino, Masato</creatorcontrib><creatorcontrib>Nagoya Surgical Oncology Group</creatorcontrib><creatorcontrib>the Nagoya Surgical Oncology Group</creatorcontrib><title>Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Although bile duct resection (BDR) in addition to pancreaticoduodenectomy (PD) is considered a surgical approach in patients with middle-third cholangiocarcinoma (MCC), available prognostic information after BDR remains very limited. The aim of this study was to reappraise BDR from the viewpoint of surgical oncology.
Methods
Patients who underwent BDR or PD for MCC between 2001 and 2010 at 32 Japanese hospitals were included. Clinicopathological factors were retrospectively compared according to surgical procedure to identify a subset cohort who benefited most from BDR.
Results
During the study, 92 patients underwent BDR (
n
= 38) or PD (
n
= 54). BDR was characterized by a shorter operation time, less blood loss, less frequent complications, and lower mortality, than PD. The incidence of positive surgical margins was 26.3% versus 5.6% (
P
= 0.007). The survival rate after BDR was significantly worse than that after PD: 38.8% versus 54.8% at 5 years (
P
= 0.035), and BDR was independently associated with deteriorated survival [hazard ratio (HR), 1.76;
P
= 0.023] by multivariable analysis. In the BDR group, tumor length < 15 mm (HR, 3.38;
P
= 0.017) and ductal margin length ≥ 10 mm (HR, 2.54;
P
= 0.018) were independent positive prognostic factors. Stratified by these two favorable factors, the 5-year survival rate was 63.0% in patients with 1/2 factors and 6.7% in those with 0 factors (
P
< 0.001).
Conclusion
In patients with MCC, BDR provided a better short-term and a worse long-term outcome than PD. However, patient selection using tumor length and ductal margin length may allow a favorable survival probability even after BDR.</description><subject>Bile</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Bile ducts</subject><subject>Bile Ducts - surgery</subject><subject>Bile Ducts, Intrahepatic</subject><subject>Cholangiocarcinoma</subject><subject>Cholangiocarcinoma - surgery</subject><subject>Hepatectomy</subject><subject>Hepatobiliary Tumors</subject><subject>Humans</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Pancreaticoduodenectomy</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Treatment Outcome</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kD1PwzAURS0EolD4AwwoEgtLwJ9xPEL5lIqKUJkt13lpXaVxsZOBf4-hBSQGJlt-511fHYROCL4glIvLSDBnPMcU51gRIXO2gw6ISE-8KMluuuOizBUtxAAdxrjEmEiGxT4aMKoKzBQ9QM-T1vrGz53NXsCs18G4aJrM19m1ayC76W2XBhFs53yb1T5kT66qGsinCxeqbLTwjWnnzlsTrGv9yhyhvdo0EY635xC93t1ORw_5eHL_OLoa55YL1eWgKJ8RXNZQVbQmBIgBlrpjqqiwojDGYFFUnJWUgzISJ04RKQRYWWGp2BCdb3LXwb_1EDu9ctFCk-qA76OmnPNSFgWTCT37gy59H9rULlGqlErSkiaKbigbfIwBar0ObmXCuyZYf_rWG986-dZfvjVLS6fb6H62gupn5VtwAtgGiGnUziH8_v1P7AdSnImv</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Jikei, Kosuke</creator><creator>Ebata, Tomoki</creator><creator>Mizuno, Takashi</creator><creator>Kyokane, Takanori</creator><creator>Matsubara, Hideo</creator><creator>Yokoyama, Shinya</creator><creator>Kato, Kenji</creator><creator>Suzumura, Kiyoshi</creator><creator>Hashimoto, Mizuo</creator><creator>Kawai, Satoru</creator><creator>Nagino, Masato</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20210401</creationdate><title>Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma</title><author>Jikei, Kosuke ; Ebata, Tomoki ; Mizuno, Takashi ; Kyokane, Takanori ; Matsubara, Hideo ; Yokoyama, Shinya ; Kato, Kenji ; Suzumura, Kiyoshi ; Hashimoto, Mizuo ; Kawai, Satoru ; Nagino, Masato</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-e924b108fedd2f11e1ae315302925c56aaa056d43824e9a70edd91755ec7d0793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bile</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Bile ducts</topic><topic>Bile Ducts - surgery</topic><topic>Bile Ducts, Intrahepatic</topic><topic>Cholangiocarcinoma</topic><topic>Cholangiocarcinoma - surgery</topic><topic>Hepatectomy</topic><topic>Hepatobiliary Tumors</topic><topic>Humans</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Pancreaticoduodenectomy</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jikei, Kosuke</creatorcontrib><creatorcontrib>Ebata, Tomoki</creatorcontrib><creatorcontrib>Mizuno, Takashi</creatorcontrib><creatorcontrib>Kyokane, Takanori</creatorcontrib><creatorcontrib>Matsubara, Hideo</creatorcontrib><creatorcontrib>Yokoyama, Shinya</creatorcontrib><creatorcontrib>Kato, Kenji</creatorcontrib><creatorcontrib>Suzumura, Kiyoshi</creatorcontrib><creatorcontrib>Hashimoto, Mizuo</creatorcontrib><creatorcontrib>Kawai, Satoru</creatorcontrib><creatorcontrib>Nagino, Masato</creatorcontrib><creatorcontrib>Nagoya Surgical Oncology Group</creatorcontrib><creatorcontrib>the Nagoya Surgical Oncology Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jikei, Kosuke</au><au>Ebata, Tomoki</au><au>Mizuno, Takashi</au><au>Kyokane, Takanori</au><au>Matsubara, Hideo</au><au>Yokoyama, Shinya</au><au>Kato, Kenji</au><au>Suzumura, Kiyoshi</au><au>Hashimoto, Mizuo</au><au>Kawai, Satoru</au><au>Nagino, Masato</au><aucorp>Nagoya Surgical Oncology Group</aucorp><aucorp>the Nagoya Surgical Oncology Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>28</volume><issue>4</issue><spage>1990</spage><epage>1999</epage><pages>1990-1999</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Although bile duct resection (BDR) in addition to pancreaticoduodenectomy (PD) is considered a surgical approach in patients with middle-third cholangiocarcinoma (MCC), available prognostic information after BDR remains very limited. The aim of this study was to reappraise BDR from the viewpoint of surgical oncology.
Methods
Patients who underwent BDR or PD for MCC between 2001 and 2010 at 32 Japanese hospitals were included. Clinicopathological factors were retrospectively compared according to surgical procedure to identify a subset cohort who benefited most from BDR.
Results
During the study, 92 patients underwent BDR (
n
= 38) or PD (
n
= 54). BDR was characterized by a shorter operation time, less blood loss, less frequent complications, and lower mortality, than PD. The incidence of positive surgical margins was 26.3% versus 5.6% (
P
= 0.007). The survival rate after BDR was significantly worse than that after PD: 38.8% versus 54.8% at 5 years (
P
= 0.035), and BDR was independently associated with deteriorated survival [hazard ratio (HR), 1.76;
P
= 0.023] by multivariable analysis. In the BDR group, tumor length < 15 mm (HR, 3.38;
P
= 0.017) and ductal margin length ≥ 10 mm (HR, 2.54;
P
= 0.018) were independent positive prognostic factors. Stratified by these two favorable factors, the 5-year survival rate was 63.0% in patients with 1/2 factors and 6.7% in those with 0 factors (
P
< 0.001).
Conclusion
In patients with MCC, BDR provided a better short-term and a worse long-term outcome than PD. However, patient selection using tumor length and ductal margin length may allow a favorable survival probability even after BDR.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32960392</pmid><doi>10.1245/s10434-020-09157-3</doi><tpages>10</tpages></addata></record> |
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| ispartof | Annals of surgical oncology, 2021-04, Vol.28 (4), p.1990-1999 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Bile Bile Duct Neoplasms - surgery Bile ducts Bile Ducts - surgery Bile Ducts, Intrahepatic Cholangiocarcinoma Cholangiocarcinoma - surgery Hepatectomy Hepatobiliary Tumors Humans Medical prognosis Medicine Medicine & Public Health Oncology Pancreaticoduodenectomy Prognosis Retrospective Studies Surgery Surgical Oncology Survival Treatment Outcome |
| title | Oncologic Reappraisal of Bile Duct Resection for Middle-Third Cholangiocarcinoma |
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