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

Kenichi Matsuo, Flavio G. Rocha, Kaori Ito, Michael I. D'Angelica, Peter J. Allen, Yuman Fong, Ronald P. Dematteo, Mithat Gonen, Itaru Endo, William R. Jarnagin

Research output: Contribution to journalArticlepeer-review

117 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)343-355
Number of pages13
JournalJournal of the American College of Surgeons
Volume215
Issue number3
DOIs
StatePublished - Sep 2012
Externally publishedYes

Keywords

  • AJCC
  • American Joint Committee on Cancer
  • disease-specific survival
  • DSS
  • FDG-PET
  • HCCA
  • hilar cholangiocarcinoma
  • magnetic resonance cholangiopancreatography
  • MDCT
  • Memorial Sloan-Kettering Cancer Center
  • MRCP
  • MSKCC
  • multidetector-row computed tomography
  • positron emission tomography with [(18) F] fluoro-2-deoxy-D-glucose

ASJC Scopus subject areas

  • Surgery

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