Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: Results of an italian multicenter analysis of 440 patients

Gennaro Nuzzo, Felice Giuliante, Francesco Ardito, Ivo Giovannini, Luca Aldrighetti, Giulio Belli, Fabrizio Bresadola, Fulvio Calise, Raffaele Dalla Valle, Davide F. D'Amico, Leandro Gennari, Stefano M. Giulini, Alfredo Guglielmi, Elio Jovine, Riccardo Pellicci, Heinrich Pernthaler, Antonio D. Pinna, Stefano Puleo, Guido Torzilli, Lorenzo CapussottiUmberto Cillo, Giorgio Ercolani, Massimo Ferrucci, Laura Mastrangelo, Nazario Portolani, Carlo Pulitanò, Dario Ribero, Andrea Ruzzenente, Vincenzo Scuderi, Bruno Federico

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. Design: Retrospective multicenter study including 17 Italian hepatobiliary surgery units. Patients: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. Main Outcome Measures: Postoperative mortality, morbidity, overall survival, and disease-free survival. Results: Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (rightor right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P=.03 and P=.006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P=.05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. Conclusions: Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.

Original languageEnglish
Pages (from-to)26-34
Number of pages9
JournalArchives of Surgery
Volume147
Issue number1
DOIs
Publication statusPublished - Jan 2012

Fingerprint

Klatskin Tumor
Mortality
Disease-Free Survival
Drainage
Hepatectomy
Jaundice
Blood Transfusion
Survival
Multivariate Analysis
Morbidity
Therapeutics
Liver
Multicenter Studies
Blood Vessels
Neoplasms
Retrospective Studies
Logistic Models
Lymph Nodes
Outcome Assessment (Health Care)
Neoplasm Metastasis

ASJC Scopus subject areas

  • Surgery

Cite this

Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma : Results of an italian multicenter analysis of 440 patients. / Nuzzo, Gennaro; Giuliante, Felice; Ardito, Francesco; Giovannini, Ivo; Aldrighetti, Luca; Belli, Giulio; Bresadola, Fabrizio; Calise, Fulvio; Dalla Valle, Raffaele; D'Amico, Davide F.; Gennari, Leandro; Giulini, Stefano M.; Guglielmi, Alfredo; Jovine, Elio; Pellicci, Riccardo; Pernthaler, Heinrich; Pinna, Antonio D.; Puleo, Stefano; Torzilli, Guido; Capussotti, Lorenzo; Cillo, Umberto; Ercolani, Giorgio; Ferrucci, Massimo; Mastrangelo, Laura; Portolani, Nazario; Pulitanò, Carlo; Ribero, Dario; Ruzzenente, Andrea; Scuderi, Vincenzo; Federico, Bruno.

In: Archives of Surgery, Vol. 147, No. 1, 01.2012, p. 26-34.

Research output: Contribution to journalArticle

Nuzzo, G, Giuliante, F, Ardito, F, Giovannini, I, Aldrighetti, L, Belli, G, Bresadola, F, Calise, F, Dalla Valle, R, D'Amico, DF, Gennari, L, Giulini, SM, Guglielmi, A, Jovine, E, Pellicci, R, Pernthaler, H, Pinna, AD, Puleo, S, Torzilli, G, Capussotti, L, Cillo, U, Ercolani, G, Ferrucci, M, Mastrangelo, L, Portolani, N, Pulitanò, C, Ribero, D, Ruzzenente, A, Scuderi, V & Federico, B 2012, 'Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: Results of an italian multicenter analysis of 440 patients', Archives of Surgery, vol. 147, no. 1, pp. 26-34. https://doi.org/10.1001/archsurg.2011.771
Nuzzo, Gennaro ; Giuliante, Felice ; Ardito, Francesco ; Giovannini, Ivo ; Aldrighetti, Luca ; Belli, Giulio ; Bresadola, Fabrizio ; Calise, Fulvio ; Dalla Valle, Raffaele ; D'Amico, Davide F. ; Gennari, Leandro ; Giulini, Stefano M. ; Guglielmi, Alfredo ; Jovine, Elio ; Pellicci, Riccardo ; Pernthaler, Heinrich ; Pinna, Antonio D. ; Puleo, Stefano ; Torzilli, Guido ; Capussotti, Lorenzo ; Cillo, Umberto ; Ercolani, Giorgio ; Ferrucci, Massimo ; Mastrangelo, Laura ; Portolani, Nazario ; Pulitanò, Carlo ; Ribero, Dario ; Ruzzenente, Andrea ; Scuderi, Vincenzo ; Federico, Bruno. / Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma : Results of an italian multicenter analysis of 440 patients. In: Archives of Surgery. 2012 ; Vol. 147, No. 1. pp. 26-34.
@article{69754cbb51c84880b54de6eeaa76b4e1,
title = "Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: Results of an italian multicenter analysis of 440 patients",
abstract = "Objective: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. Design: Retrospective multicenter study including 17 Italian hepatobiliary surgery units. Patients: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. Main Outcome Measures: Postoperative mortality, morbidity, overall survival, and disease-free survival. Results: Postoperative mortality and morbidity after liver resection were 10.1{\%} and 47.6{\%}, respectively. At multivariate logistic regression, extent of resection (rightor right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P=.03 and P=.006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3{\%} vs 10.7{\%}). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0{\%} to 53.2{\%}, and mortality slightly decreased from 13.6{\%} to 10.8{\%}. Median overall survival significantly increased from 16 to 30 months (P=.05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. Conclusions: Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.",
author = "Gennaro Nuzzo and Felice Giuliante and Francesco Ardito and Ivo Giovannini and Luca Aldrighetti and Giulio Belli and Fabrizio Bresadola and Fulvio Calise and {Dalla Valle}, Raffaele and D'Amico, {Davide F.} and Leandro Gennari and Giulini, {Stefano M.} and Alfredo Guglielmi and Elio Jovine and Riccardo Pellicci and Heinrich Pernthaler and Pinna, {Antonio D.} and Stefano Puleo and Guido Torzilli and Lorenzo Capussotti and Umberto Cillo and Giorgio Ercolani and Massimo Ferrucci and Laura Mastrangelo and Nazario Portolani and Carlo Pulitan{\`o} and Dario Ribero and Andrea Ruzzenente and Vincenzo Scuderi and Bruno Federico",
year = "2012",
month = "1",
doi = "10.1001/archsurg.2011.771",
language = "English",
volume = "147",
pages = "26--34",
journal = "Archives of Surgery",
issn = "0004-0010",
publisher = "American Medical Association",
number = "1",

}

TY - JOUR

T1 - Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma

T2 - Results of an italian multicenter analysis of 440 patients

AU - Nuzzo, Gennaro

AU - Giuliante, Felice

AU - Ardito, Francesco

AU - Giovannini, Ivo

AU - Aldrighetti, Luca

AU - Belli, Giulio

AU - Bresadola, Fabrizio

AU - Calise, Fulvio

AU - Dalla Valle, Raffaele

AU - D'Amico, Davide F.

AU - Gennari, Leandro

AU - Giulini, Stefano M.

AU - Guglielmi, Alfredo

AU - Jovine, Elio

AU - Pellicci, Riccardo

AU - Pernthaler, Heinrich

AU - Pinna, Antonio D.

AU - Puleo, Stefano

AU - Torzilli, Guido

AU - Capussotti, Lorenzo

AU - Cillo, Umberto

AU - Ercolani, Giorgio

AU - Ferrucci, Massimo

AU - Mastrangelo, Laura

AU - Portolani, Nazario

AU - Pulitanò, Carlo

AU - Ribero, Dario

AU - Ruzzenente, Andrea

AU - Scuderi, Vincenzo

AU - Federico, Bruno

PY - 2012/1

Y1 - 2012/1

N2 - Objective: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. Design: Retrospective multicenter study including 17 Italian hepatobiliary surgery units. Patients: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. Main Outcome Measures: Postoperative mortality, morbidity, overall survival, and disease-free survival. Results: Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (rightor right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P=.03 and P=.006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P=.05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. Conclusions: Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.

AB - Objective: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma. Design: Retrospective multicenter study including 17 Italian hepatobiliary surgery units. Patients: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007. Main Outcome Measures: Postoperative mortality, morbidity, overall survival, and disease-free survival. Results: Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (rightor right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P=.03 and P=.006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P=.05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival. Conclusions: Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.

UR - http://www.scopus.com/inward/record.url?scp=84856024018&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856024018&partnerID=8YFLogxK

U2 - 10.1001/archsurg.2011.771

DO - 10.1001/archsurg.2011.771

M3 - Article

C2 - 22250108

AN - SCOPUS:84856024018

VL - 147

SP - 26

EP - 34

JO - Archives of Surgery

JF - Archives of Surgery

SN - 0004-0010

IS - 1

ER -