Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi-institutional analysis

Bradley N. Reames, Aslam Ejaz, Bas Groot Koerkamp, Sorin Alexandrescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Todd W. Bauer, Feng Shen, George A. Poultsides, Guillaume Martel, James Wallis Marsh, Timothy M. Pawlik

Research output: Contribution to journalArticle

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Abstract

Background: Major vascular involvement (IVC or portal vein) for intrahepatic cholangiocarcinoma (ICC) has traditionally been considered a contraindication to resection. We sought to define perioperative outcomes and survival of ICC patients undergoing hepatectomy with major vascular resection in a large international multi-institutional database. Methods: A total of 1087 ICC patients who underwent curative-intent hepatectomy between 1990 and 2016 were identified from 13 institutions. Multivariable logistic and cox regressions were used to determine the impact of major vascular resection on perioperative and survival outcomes. Results: Of 1087 patients who underwent resection, 128 (11.8%) also underwent major vascular resection (21 [16.4%] IVC resections, 98 [76.6%] PV resections, 9 [7.0%] combined resections). Despite more advanced disease, major vascular resection was not associated with the risk of any complication (OR = 0.68, 95%CI 0.32-1.45) or major complications (OR = 0.95, 95%CI 0.49-2.00). Post-operative mortality was also comparable between groups (OR = 1.05, 95%CI 0.32-3.47). In addition, median recurrence-free (14.0 vs 14.7 months, HR = 0.737, 95%CI 0.49-1.10) and overall (33.4 vs 40.2 months, HR = 0.71, 95%CI 0.359-1.40) survival were similar among patients who did and did not undergo major vascular resection (both P > 0.05). Conclusion: Among patients with ICC, major vascular resection was not associated with worse perioperative or oncologic outcomes. Concurrent major vascular resection should be considered in appropriately selected patients with ICC undergoing hepatectomy.

Original languageEnglish (US)
Pages (from-to)133-139
Number of pages7
JournalJournal of Surgical Oncology
Volume116
Issue number2
DOIs
StatePublished - Aug 1 2017

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Cholangiocarcinoma
Blood Vessels
Survival
Hepatectomy
Portal Vein
Vascular Diseases
Logistic Models
Databases
Recurrence
Mortality

Keywords

  • cholangiocarcinoma
  • intrahepatic
  • outcomes
  • resection
  • vascular

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma : A multi-institutional analysis. / Reames, Bradley N.; Ejaz, Aslam; Koerkamp, Bas Groot; Alexandrescu, Sorin; Marques, Hugo P.; Aldrighetti, Luca; Maithel, Shishir K.; Pulitano, Carlo; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Martel, Guillaume; Marsh, James Wallis; Pawlik, Timothy M.

In: Journal of Surgical Oncology, Vol. 116, No. 2, 01.08.2017, p. 133-139.

Research output: Contribution to journalArticle

Reames, BN, Ejaz, A, Koerkamp, BG, Alexandrescu, S, Marques, HP, Aldrighetti, L, Maithel, SK, Pulitano, C, Bauer, TW, Shen, F, Poultsides, GA, Martel, G, Marsh, JW & Pawlik, TM 2017, 'Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi-institutional analysis', Journal of Surgical Oncology, vol. 116, no. 2, pp. 133-139. https://doi.org/10.1002/jso.24633
Reames, Bradley N. ; Ejaz, Aslam ; Koerkamp, Bas Groot ; Alexandrescu, Sorin ; Marques, Hugo P. ; Aldrighetti, Luca ; Maithel, Shishir K. ; Pulitano, Carlo ; Bauer, Todd W. ; Shen, Feng ; Poultsides, George A. ; Martel, Guillaume ; Marsh, James Wallis ; Pawlik, Timothy M. / Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma : A multi-institutional analysis. In: Journal of Surgical Oncology. 2017 ; Vol. 116, No. 2. pp. 133-139.
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abstract = "Background: Major vascular involvement (IVC or portal vein) for intrahepatic cholangiocarcinoma (ICC) has traditionally been considered a contraindication to resection. We sought to define perioperative outcomes and survival of ICC patients undergoing hepatectomy with major vascular resection in a large international multi-institutional database. Methods: A total of 1087 ICC patients who underwent curative-intent hepatectomy between 1990 and 2016 were identified from 13 institutions. Multivariable logistic and cox regressions were used to determine the impact of major vascular resection on perioperative and survival outcomes. Results: Of 1087 patients who underwent resection, 128 (11.8{\%}) also underwent major vascular resection (21 [16.4{\%}] IVC resections, 98 [76.6{\%}] PV resections, 9 [7.0{\%}] combined resections). Despite more advanced disease, major vascular resection was not associated with the risk of any complication (OR = 0.68, 95{\%}CI 0.32-1.45) or major complications (OR = 0.95, 95{\%}CI 0.49-2.00). Post-operative mortality was also comparable between groups (OR = 1.05, 95{\%}CI 0.32-3.47). In addition, median recurrence-free (14.0 vs 14.7 months, HR = 0.737, 95{\%}CI 0.49-1.10) and overall (33.4 vs 40.2 months, HR = 0.71, 95{\%}CI 0.359-1.40) survival were similar among patients who did and did not undergo major vascular resection (both P > 0.05). Conclusion: Among patients with ICC, major vascular resection was not associated with worse perioperative or oncologic outcomes. Concurrent major vascular resection should be considered in appropriately selected patients with ICC undergoing hepatectomy.",
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T2 - A multi-institutional analysis

AU - Reames, Bradley N.

AU - Ejaz, Aslam

AU - Koerkamp, Bas Groot

AU - Alexandrescu, Sorin

AU - Marques, Hugo P.

AU - Aldrighetti, Luca

AU - Maithel, Shishir K.

AU - Pulitano, Carlo

AU - Bauer, Todd W.

AU - Shen, Feng

AU - Poultsides, George A.

AU - Martel, Guillaume

AU - Marsh, James Wallis

AU - Pawlik, Timothy M.

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N2 - Background: Major vascular involvement (IVC or portal vein) for intrahepatic cholangiocarcinoma (ICC) has traditionally been considered a contraindication to resection. We sought to define perioperative outcomes and survival of ICC patients undergoing hepatectomy with major vascular resection in a large international multi-institutional database. Methods: A total of 1087 ICC patients who underwent curative-intent hepatectomy between 1990 and 2016 were identified from 13 institutions. Multivariable logistic and cox regressions were used to determine the impact of major vascular resection on perioperative and survival outcomes. Results: Of 1087 patients who underwent resection, 128 (11.8%) also underwent major vascular resection (21 [16.4%] IVC resections, 98 [76.6%] PV resections, 9 [7.0%] combined resections). Despite more advanced disease, major vascular resection was not associated with the risk of any complication (OR = 0.68, 95%CI 0.32-1.45) or major complications (OR = 0.95, 95%CI 0.49-2.00). Post-operative mortality was also comparable between groups (OR = 1.05, 95%CI 0.32-3.47). In addition, median recurrence-free (14.0 vs 14.7 months, HR = 0.737, 95%CI 0.49-1.10) and overall (33.4 vs 40.2 months, HR = 0.71, 95%CI 0.359-1.40) survival were similar among patients who did and did not undergo major vascular resection (both P > 0.05). Conclusion: Among patients with ICC, major vascular resection was not associated with worse perioperative or oncologic outcomes. Concurrent major vascular resection should be considered in appropriately selected patients with ICC undergoing hepatectomy.

AB - Background: Major vascular involvement (IVC or portal vein) for intrahepatic cholangiocarcinoma (ICC) has traditionally been considered a contraindication to resection. We sought to define perioperative outcomes and survival of ICC patients undergoing hepatectomy with major vascular resection in a large international multi-institutional database. Methods: A total of 1087 ICC patients who underwent curative-intent hepatectomy between 1990 and 2016 were identified from 13 institutions. Multivariable logistic and cox regressions were used to determine the impact of major vascular resection on perioperative and survival outcomes. Results: Of 1087 patients who underwent resection, 128 (11.8%) also underwent major vascular resection (21 [16.4%] IVC resections, 98 [76.6%] PV resections, 9 [7.0%] combined resections). Despite more advanced disease, major vascular resection was not associated with the risk of any complication (OR = 0.68, 95%CI 0.32-1.45) or major complications (OR = 0.95, 95%CI 0.49-2.00). Post-operative mortality was also comparable between groups (OR = 1.05, 95%CI 0.32-3.47). In addition, median recurrence-free (14.0 vs 14.7 months, HR = 0.737, 95%CI 0.49-1.10) and overall (33.4 vs 40.2 months, HR = 0.71, 95%CI 0.359-1.40) survival were similar among patients who did and did not undergo major vascular resection (both P > 0.05). Conclusion: Among patients with ICC, major vascular resection was not associated with worse perioperative or oncologic outcomes. Concurrent major vascular resection should be considered in appropriately selected patients with ICC undergoing hepatectomy.

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