Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease

Anne Marleen van Keulen; Stefan Buettner; Pim B. Olthof; Heinz Josef Klümpen; Joris I. Erdmann; Laura Izquierdo-Sanchez; Jesus M. Banales; Benjamin Goeppert; Stephanie Roessler; Krzysztof Zieniewicz; Angela Lamarca; Juan W. Valle; Adelaida La Casta; Frederik J.H. Hoogwater; Matteo Donadon; Alexander Scheiter; Marco Marzioni; Jorge Adeva; Edita Kiudeliene; Jesús María Urman Fernández; Gianpaolo Vidili; Tudor Mocan; Luca Fabris; Marcin Krawczyk; Trine Folseraas; Cristina Dopazo; Olivier Detry; Theodor Voiosu; Viorel Scripcariu; Francesca Biancaniello; Chiara Braconi; Rocio I.R. Macias; Bas Groot Koerkamp

doi:10.1245/s10434-024-15582-5

Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease

Anne Marleen van Keulen, Stefan Buettner, Pim B. Olthof^*, Heinz Josef Klümpen, Joris I. Erdmann, Laura Izquierdo-Sanchez, Jesus M. Banales, Benjamin Goeppert, Stephanie Roessler, Krzysztof Zieniewicz, Angela Lamarca, Juan W. Valle, Adelaida La Casta, Frederik J.H. Hoogwater, Matteo Donadon, Alexander Scheiter, Marco Marzioni, Jorge Adeva, Edita Kiudeliene, Jesús María Urman FernándezGianpaolo Vidili, Tudor Mocan, Luca Fabris, Marcin Krawczyk, Trine Folseraas, Cristina Dopazo, Olivier Detry, Theodor Voiosu, Viorel Scripcariu, Francesca Biancaniello, Chiara Braconi, Rocio I.R. Macias, Bas Groot Koerkamp

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background:

Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy.

Methods:

Patients with a diagnosis of pCCA between 1997–2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS.

Results:

Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55–1.07).

Conclusions:

Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.

Original language	English
Pages (from-to)	6495-6503
Number of pages	9
Journal	Annals of Surgical Oncology
Volume	31
Issue number	10
DOIs	https://doi.org/10.1245/s10434-024-15582-5
Publication status	Published - Oct 2024

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Publisher Copyright:
© The Author(s) 2024.

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10.1245/s10434-024-15582-5Licence: CC BY

Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized DiseaseFinal published version, 521 KBLicence: CC BY

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van Keulen, A. M., Buettner, S., Olthof, P. B., Klümpen, H. J., Erdmann, J. I., Izquierdo-Sanchez, L., Banales, J. M., Goeppert, B., Roessler, S., Zieniewicz, K., Lamarca, A., Valle, J. W., La Casta, A., Hoogwater, F. J. H., Donadon, M., Scheiter, A., Marzioni, M., Adeva, J., Kiudeliene, E., ... Groot Koerkamp, B. (2024). Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease. Annals of Surgical Oncology, 31(10), 6495-6503. https://doi.org/10.1245/s10434-024-15582-5

@article{bc5739ee1d4e43f6b3da6b27a8bfa085,

title = "Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease",

abstract = "Background: Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy. Methods: Patients with a diagnosis of pCCA between 1997–2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS.Results:Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55–1.07). Conclusions: Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.",

author = "{van Keulen}, {Anne Marleen} and Stefan Buettner and Olthof, {Pim B.} and Kl{\"u}mpen, {Heinz Josef} and Erdmann, {Joris I.} and Laura Izquierdo-Sanchez and Banales, {Jesus M.} and Benjamin Goeppert and Stephanie Roessler and Krzysztof Zieniewicz and Angela Lamarca and Valle, {Juan W.} and {La Casta}, Adelaida and Hoogwater, {Frederik J.H.} and Matteo Donadon and Alexander Scheiter and Marco Marzioni and Jorge Adeva and Edita Kiudeliene and Fern{\'a}ndez, {Jes{\'u}s Mar{\'i}a Urman} and Gianpaolo Vidili and Tudor Mocan and Luca Fabris and Marcin Krawczyk and Trine Folseraas and Cristina Dopazo and Olivier Detry and Theodor Voiosu and Viorel Scripcariu and Francesca Biancaniello and Chiara Braconi and Macias, {Rocio I.R.} and {Groot Koerkamp}, Bas",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = oct,

doi = "10.1245/s10434-024-15582-5",

language = "English",

volume = "31",

pages = "6495--6503",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer Science+Business Media",

number = "10",

}

van Keulen, AM, Buettner, S , Olthof, PB, Klümpen, HJ, Erdmann, JI, Izquierdo-Sanchez, L, Banales, JM, Goeppert, B, Roessler, S, Zieniewicz, K, Lamarca, A, Valle, JW, La Casta, A, Hoogwater, FJH, Donadon, M, Scheiter, A, Marzioni, M, Adeva, J, Kiudeliene, E, Fernández, JMU, Vidili, G, Mocan, T, Fabris, L, Krawczyk, M, Folseraas, T, Dopazo, C, Detry, O, Voiosu, T, Scripcariu, V, Biancaniello, F, Braconi, C, Macias, RIR & Groot Koerkamp, B 2024, 'Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease', Annals of Surgical Oncology, vol. 31, no. 10, pp. 6495-6503. https://doi.org/10.1245/s10434-024-15582-5

TY - JOUR

T1 - Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease

AU - van Keulen, Anne Marleen

AU - Buettner, Stefan

AU - Olthof, Pim B.

AU - Klümpen, Heinz Josef

AU - Erdmann, Joris I.

AU - Izquierdo-Sanchez, Laura

AU - Banales, Jesus M.

AU - Goeppert, Benjamin

AU - Roessler, Stephanie

AU - Zieniewicz, Krzysztof

AU - Lamarca, Angela

AU - Valle, Juan W.

AU - La Casta, Adelaida

AU - Hoogwater, Frederik J.H.

AU - Donadon, Matteo

AU - Scheiter, Alexander

AU - Marzioni, Marco

AU - Adeva, Jorge

AU - Kiudeliene, Edita

AU - Fernández, Jesús María Urman

AU - Vidili, Gianpaolo

AU - Mocan, Tudor

AU - Fabris, Luca

AU - Krawczyk, Marcin

AU - Folseraas, Trine

AU - Dopazo, Cristina

AU - Detry, Olivier

AU - Voiosu, Theodor

AU - Scripcariu, Viorel

AU - Biancaniello, Francesca

AU - Braconi, Chiara

AU - Macias, Rocio I.R.

AU - Groot Koerkamp, Bas

PY - 2024/10

Y1 - 2024/10

N2 - Background: Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy. Methods: Patients with a diagnosis of pCCA between 1997–2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS.Results:Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55–1.07). Conclusions: Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.

AB - Background: Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy. Methods: Patients with a diagnosis of pCCA between 1997–2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS.Results:Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55–1.07). Conclusions: Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.

UR - http://www.scopus.com/inward/record.url?scp=85196256722&partnerID=8YFLogxK

U2 - 10.1245/s10434-024-15582-5

DO - 10.1245/s10434-024-15582-5

M3 - Article

C2 - 38995450

AN - SCOPUS:85196256722

SN - 1068-9265

VL - 31

SP - 6495

EP - 6503

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 10

ER -

Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease

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