Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group
Andrea Ruzzenente, Fabio Bagante, Pim B. Olthof, Luca Aldrighetti, Ruslan Alikhanov, Matteo Cescon, Bas Groot Koerkamp, William R. Jarnagin, Silvio Nadalin, Johann Pratschke, Moritz Schmelzle, Ernesto Sparrelid, Hauke Lang, Calogero Iacono, Thomas M. van Gulik, Alfredo Guglielmi, Alexandros Andreou, F. Bartsch, Christian Benzing, Stefan Buettner, Tommaso Campagnaro, Ivan Capobianco, R. Charco, Philip de Reuver, E. de Savornin Lohman, Cornelis H.C. Dejong, Михаил Ефанов, Joris I. Erdmann, Lotte C. Franken, Giovanna Giovinazzo, Mariano Cesare Giglio, Concepción Gómez‐Gavara, F. Heid, Jan N.M. IJzermans, John Isaac, Hannes Jansson, Marjolein A. P. Ligthart, Shishir K. Maithel, Massimo Malagó, Hafiz Malik, Paolo Muiesan, Steven W.M. Olde Damink, Leonard Quinn, Francesca Ratti, Matteo Ravaioli, Jens Rolinger, E. Schadde, Matteo Serenari, Roberto Troisi, Stijn van Laarhoven, Jeroen L.A. van Vugt
Abstract
BACKGROUND: Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. METHODS: Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. RESULTS: Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). CONCLUSIONS: In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.