Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma Journal Article
| Authors: | Jarnagin, W. R.; Bowne, W.; Klimstra, D. S.; Ben-Porat, L.; Roggin, K.; Cymes, K.; Fong, Y.; DeMatteo, R. P.; D'Angelica, M.; Koea, J.; Blumgart, L. H.; Chapman, W.; Stain, S. C.; Pitt, H. A.; Hemming, A. W.; Adams, R. B.; Clary, B. M. |
| Article Title: | Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma |
| Abstract: | Objective: The current study compares outcome after resection of papillary hilar cholangiocarcinoma to that of the more common nodular-sclerosing subtype. Methods: Clinical, radiologic, histopathologic, and survival data on all patients with hilar cholangiocarcinoma were analyzed. Resected tumors were reexamined and classified as nodular-sclerosing (no component of papillary carcinoma) or papillary (any component of papillary carcinoma); for papillary tumors, the proportion of invasive carcinoma present was determined. Differences in the clinical behavior and histopathologic features of nodular-sclerosing and papillary tumors were assessed. Results: From January 1991 to November 2003, 279 patients were evaluated, 154 men (55.2%) and 125 women (44.8%), with a mean age of 65.4 ± 0.7 years (median = 68, range 23-87 years). Of the 215 patients explored, 106 (49.5%) underwent a complete gross resection. An en bloc partial hepatectomy (n = 87) and an RO resection (n = 82) were independent predictors of favorable outcome. Operative mortality was 7.5% but was 2.8% over the last 4 years of the study, and there were no operative deaths in the last 33 consecutive resections. Twenty-five resected tumors (23.6%) contained a papillary component: 12 were minimally or noninvasive (<10% invasive cancer) and 13 had an invasive component ranging from 10% to 95% (≥10%). Patients with papillary and nodular-sclerosing tumors had similar demographics, operative procedures, and proportion of RO resections. By contrast, papillary tumors were significantly larger, more often well-differentiated, and earlier stage. Disease-specific survival after resection of papillary tumors (55.7 months) was greater than after resection of nodular-sclerosing lesions (33.5 months, P = 0.013). The papillary phenotype was an independent predictor of survival, although the benefit was more pronounced for less invasive tumors. Conclusions: The presence of a component of papillary carcinoma is more common than previous reports have suggested and is an important determinant of survival after resection of hilar cholangiocarcinoma. Copyright © 2005 by Lippincott Williams & Wilkins. |
| Keywords: | survival; adult; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; surgical technique; major clinical study; histopathology; conference paper; phenotype; demography; liver resection; surgical mortality; hepatectomy; invasive carcinoma; neoplasm invasiveness; bile duct carcinoma; bile duct neoplasms; bile ducts, intrahepatic; cholangiocarcinoma; papilloma; tumor classification; adenocarcinoma, papillary; partial hepatectomy; hepatography |
| Journal Title: | Annals of Surgery |
| Volume: | 241 |
| Issue: | 5 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2005-05-01 |
| Start Page: | 703 |
| End Page: | 714 |
| Language: | English |
| DOI: | 10.1097/01.sla.0000160817.94472.fd |
| PUBMED: | 15849506 |
| PROVIDER: | scopus |
| PMCID: | PMC1357125 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 62" - "Export Date: 24 October 2012" - "CODEN: ANSUA" - "Source: Scopus" |
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