The blumgart preoperative staging system for hilar cholangiocarcinoma: Analysis of resectability and outcomes in 380 patients Journal Article

  

Authors:	Matsuo, K.; Rocha, F. G.; Ito, K.; D'Angelica, M. I.; Allen, P. J.; Fong, Y.; DeMatteo, R. P.; Gonen, M.; Endo, I.; Jarnagin, W. R.
Article Title:	The blumgart preoperative staging system for hilar cholangiocarcinoma: Analysis of resectability and outcomes in 380 patients
Abstract:	Complete resection of hilar cholangiocarcinoma (HCCA) is a critical determinant of long-term survival. This study validates a previously reported preoperative clinical T staging system for determining resectability of HCCA. Consecutive patients with confirmed HCCA treated over an 18-year period were included. Patient demographics, preoperative imaging studies, resection type, margin status, lymph node status, histopathologic findings, morbidity, and outcomes were entered prospectively and analyzed retrospectively; changes in these variables over time were assessed. All patients were placed into 1 of 3 stages based on the extent of ductal involvement by tumor, portal vein compromise, or lobar atrophy. From March 1991 through December 2008, 380 patients were evaluated. Eighty-five patients had unresectable disease; 295 patients underwent exploration with curative intent. One hundred fifty-seven patients underwent resection: 129 (82.2%) had a concomitant hepatic resection and 120 (76.4%) had an R0 resection. Of the 32 actual 5-year survivors (120 at risk), 30 patients (93.8%) had a concomitant hepatic resection. In patients who underwent an R0 resection, concomitant partial hepatectomy, well-differentiated histology, and negative lymph nodes were independent predictors of long-term survival. In the 376 patients whose disease could be staged, the preoperative clinical T staging system predicted resectability (p < 0.001), metastatic disease (p < 0.001), and R0 resection (p = 0.007). The preoperative clinical T staging system of Blumgart, defined by the radial and longitudinal tumor extent, accurately predicts resectability of HCCA. The full outcomes benefit of resection is realized only if a concomitant partial hepatectomy is performed. © 2012 American College of Surgeons.
Keywords:	adult; treatment outcome; aged; major clinical study; histopathology; ascites; gastrointestinal hemorrhage; disease free survival; cancer staging; lymph node metastasis; preoperative evaluation; pancreaticoduodenectomy; bleeding; abdominal abscess; distant metastasis; pneumonia; liver failure; preoperative period; fdg-pet; bile leakage; blood transfusion; liver resection; bile duct carcinoma; biliary tract surgery; wound infection; perioperative complication; disease-specific survival; partial hepatectomy; hilar cholangiocarcinoma; memorial sloan-kettering cancer center; mskcc; mdct; magnetic resonance cholangiopancreatography; ajcc; cancer prognosis; american joint committee on cancer; dss; hcca; mrcp; multidetector-row computed tomography; positron emission tomography with [(18) f] fluoro-2-deoxy-d-glucose
Journal Title:	Journal of the American College of Surgeons
Volume:	215
Issue:	3
ISSN:	1072-7515
Publisher:	Elsevier Science, Inc.
Date Published:	2012-09-01
Start Page:	343
End Page:	355
Language:	English
DOI:	10.1016/j.jamcollsurg.2012.05.025
PROVIDER:	scopus
PUBMED:	22749003
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84865233568&partnerID=40&md5=1922ee6484ee088d2f65cfee8bfc21df
Notes:	--- - "Export Date: 1 October 2012" - "CODEN: JACSE" - "Source: Scopus"

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