Work-Up and Outcome of Hepatic Resection for Peri-Hilar Cholangiocarcinoma (PH-CCA) without Staging Laparoscopy

Autor: Santhalingam Jegatheeswaran, Panagiotis Stathakis, Harry V. M. Spiers, Fawwaz Mohammed, Panagiotis Petras, Thomas Satyadas, Michael J. Parker, Angela Lamarca, Saurabh Jamdar, Aali J. Sheen, Ajith K. Siriwardena
Přispěvatelé: Spiers, Harry VM [0000-0001-7308-2711], Lamarca, Angela [0000-0001-9696-6122], Apollo - University of Cambridge Repository
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Cancers; Volume 14; Issue 7; Pages: 1841
Cancers (Basel)
ISSN: 2072-6694
DOI: 10.3390/cancers14071841
Popis: Background: This study reports the outcome of a work-up programme for resection of peri-hilar cholangiocarcinoma (PH-CCA) without the use of staging laparoscopy. Methods: This is a clinical case cohort series of patients undergoing surgical resection of PH-CCA without the use of staging laparoscopy in the work-up algorithm. During the 13 years from 1 January 2009 to 1 January 2022, 32 patients underwent laparotomy for planned surgical resection of PH-CCA. Data were collected on demographic profile, admission biochemistry, radiology, pre-operative intervention, operation and outcome, together with post-operative complications and disease-free and overall survival. Results: All patients underwent pre-operative contrast-enhanced CT. Twenty-four (75%) underwent pre-operative MR. Twenty-three (72%) underwent pre-operative biliary drainage. Twenty-nine patients (91%) had either type III or IV peri-hilar cholangiocarcinoma. One patient (3%) in this series underwent a non-resectional laparotomy. Twenty-nine (91%) had a final histopathological diagnosis of PH-CCA. One further patient had a final diagnosis of an intraductal papillary neoplasm of the biliary tree (IPNB) with high-grade dysplasia but no invasive cancer. Eleven patients (36%) received chemotherapy after surgery. The median (95% CI) time to recurrence was 14 (7–31) months. The median survival was 25 (18-upper limit not reached) months. Conclusion: This cohort of 32 patients undergoing attempted resection for PH-CCA without the use of staging laparoscopy in the work-up algorithm indicates that with careful attention to patient fitness and cross-sectional and interventional radiologic/endoscopic imaging, a very low non-therapeutic laparotomy rate of 3% can be achieved and sustained.
Databáze: OpenAIRE
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