Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making

David M de Jong; Sanne van de Vondervoort; Roy S Dwarkasing; Michael Doukas; Rogier P Voermans; Robert C Verdonk; Wojciech G Polak; Jeroen de Jonge; Bas Groot Koerkamp; Marco J Bruno; Lydi M J W van Driel

doi:10.1055/a-2005-3679

Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making

David M de Jong, Sanne van de Vondervoort, Roy S Dwarkasing, Michael Doukas, Rogier P Voermans, Robert C Verdonk, Wojciech G Polak, Jeroen de Jonge, Bas Groot Koerkamp, Marco J Bruno, Lydi M J W van Driel^*

^*Corresponding author for this work

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Abstract

Background and study aims Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with extraregional metastatic LNs (MLNs). This study investigates the added value of preoperative endoscopic ultrasound (EUS) with or without tissue acquisition (TA) for the detection of MLNs in patients with resectable pCCA. Patients and methods In this retrospective, multicenter cohort study, patients with potentially resectable pCCA who underwent EUS preoperatively between 2010-2020, were included. The clinical impact of EUS-TA was defined as the percentage of patients who did not undergo surgical resection due to MLNs found with EUS-TA. Findings of cross-sectional imaging were compared with EUS-TA findings and surgery. Results EUS was performed on 141 patients, of whom 107 (76 %) had suspicious LNs on cross-sectional imaging. Surgical exploration was prevented in 20 patients (14 %) because EUS-TA detected MLNs, of which 17 (85 %) were extraregional. Finally, 74 patients (52 %) underwent surgical exploration followed by complete resection in 40 (28 %). MLNs were identified at definitive pathology in 24 (33 %) patients, of which 9 (38 %) were extraregional and 15 (63 %) regional. Conclusions EUS-TA may be of value in patients with potentially resectable pCCA based on preoperative cross-sectional imaging, regardless of lymphadenopathy at cross-sectional imaging. A prospective study in which a comprehensive EUS investigation with LN assessment and EUS-TA of LNs is performed routinely should confirm this promise.

Original language	English
Pages (from-to)	E162-E168
Number of pages	7
Journal	Endoscopy International Open
Volume	11
Issue number	2
DOIs	https://doi.org/10.1055/a-2005-3679
Publication status	Published - Feb 2023

Bibliographical note

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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de Jong, D. M., van de Vondervoort, S., Dwarkasing, R. S., Doukas, M., Voermans, R. P., Verdonk, R. C., Polak, W. G., de Jonge, J., Koerkamp, B. G., Bruno, M. J., & van Driel, L. M. J. W. (2023). Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making. Endoscopy International Open, 11(2), E162-E168. https://doi.org/10.1055/a-2005-3679

@article{614fe6632cda4c0594e443d9ff4c5d54,

title = "Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making",

abstract = " Background and study aims Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with extraregional metastatic LNs (MLNs). This study investigates the added value of preoperative endoscopic ultrasound (EUS) with or without tissue acquisition (TA) for the detection of MLNs in patients with resectable pCCA. Patients and methods In this retrospective, multicenter cohort study, patients with potentially resectable pCCA who underwent EUS preoperatively between 2010-2020, were included. The clinical impact of EUS-TA was defined as the percentage of patients who did not undergo surgical resection due to MLNs found with EUS-TA. Findings of cross-sectional imaging were compared with EUS-TA findings and surgery. Results EUS was performed on 141 patients, of whom 107 (76 \%) had suspicious LNs on cross-sectional imaging. Surgical exploration was prevented in 20 patients (14 \%) because EUS-TA detected MLNs, of which 17 (85 \%) were extraregional. Finally, 74 patients (52 \%) underwent surgical exploration followed by complete resection in 40 (28 \%). MLNs were identified at definitive pathology in 24 (33 \%) patients, of which 9 (38 \%) were extraregional and 15 (63 \%) regional. Conclusions EUS-TA may be of value in patients with potentially resectable pCCA based on preoperative cross-sectional imaging, regardless of lymphadenopathy at cross-sectional imaging. A prospective study in which a comprehensive EUS investigation with LN assessment and EUS-TA of LNs is performed routinely should confirm this promise. ",

author = "\{de Jong\}, \{David M\} and \{van de Vondervoort\}, Sanne and Dwarkasing, \{Roy S\} and Michael Doukas and Voermans, \{Rogier P\} and Verdonk, \{Robert C\} and Polak, \{Wojciech G\} and \{de Jonge\}, Jeroen and Koerkamp, \{Bas Groot\} and Bruno, \{Marco J\} and \{van Driel\}, \{Lydi M J W\}",

note = "The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).",

year = "2023",

month = feb,

doi = "10.1055/a-2005-3679",

language = "English",

volume = "11",

pages = "E162--E168",

journal = "Endoscopy International Open",

issn = "2364-3722",

publisher = "Georg Thieme Verlag",

number = "2",

}

de Jong, DM, van de Vondervoort, S, Dwarkasing, RS , Doukas, M, Voermans, RP, Verdonk, RC, Polak, WG , de Jonge, J , Koerkamp, BG , Bruno, MJ & van Driel, LMJW 2023, 'Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making', Endoscopy International Open, vol. 11, no. 2, pp. E162-E168. https://doi.org/10.1055/a-2005-3679

TY - JOUR

T1 - Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma

T2 - impact on clinical decision-making

AU - de Jong, David M

AU - van de Vondervoort, Sanne

AU - Dwarkasing, Roy S

AU - Doukas, Michael

AU - Voermans, Rogier P

AU - Verdonk, Robert C

AU - Polak, Wojciech G

AU - de Jonge, Jeroen

AU - Koerkamp, Bas Groot

AU - Bruno, Marco J

AU - van Driel, Lydi M J W

N1 - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

PY - 2023/2

Y1 - 2023/2

N2 - Background and study aims Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with extraregional metastatic LNs (MLNs). This study investigates the added value of preoperative endoscopic ultrasound (EUS) with or without tissue acquisition (TA) for the detection of MLNs in patients with resectable pCCA. Patients and methods In this retrospective, multicenter cohort study, patients with potentially resectable pCCA who underwent EUS preoperatively between 2010-2020, were included. The clinical impact of EUS-TA was defined as the percentage of patients who did not undergo surgical resection due to MLNs found with EUS-TA. Findings of cross-sectional imaging were compared with EUS-TA findings and surgery. Results EUS was performed on 141 patients, of whom 107 (76 %) had suspicious LNs on cross-sectional imaging. Surgical exploration was prevented in 20 patients (14 %) because EUS-TA detected MLNs, of which 17 (85 %) were extraregional. Finally, 74 patients (52 %) underwent surgical exploration followed by complete resection in 40 (28 %). MLNs were identified at definitive pathology in 24 (33 %) patients, of which 9 (38 %) were extraregional and 15 (63 %) regional. Conclusions EUS-TA may be of value in patients with potentially resectable pCCA based on preoperative cross-sectional imaging, regardless of lymphadenopathy at cross-sectional imaging. A prospective study in which a comprehensive EUS investigation with LN assessment and EUS-TA of LNs is performed routinely should confirm this promise.

AB - Background and study aims Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with extraregional metastatic LNs (MLNs). This study investigates the added value of preoperative endoscopic ultrasound (EUS) with or without tissue acquisition (TA) for the detection of MLNs in patients with resectable pCCA. Patients and methods In this retrospective, multicenter cohort study, patients with potentially resectable pCCA who underwent EUS preoperatively between 2010-2020, were included. The clinical impact of EUS-TA was defined as the percentage of patients who did not undergo surgical resection due to MLNs found with EUS-TA. Findings of cross-sectional imaging were compared with EUS-TA findings and surgery. Results EUS was performed on 141 patients, of whom 107 (76 %) had suspicious LNs on cross-sectional imaging. Surgical exploration was prevented in 20 patients (14 %) because EUS-TA detected MLNs, of which 17 (85 %) were extraregional. Finally, 74 patients (52 %) underwent surgical exploration followed by complete resection in 40 (28 %). MLNs were identified at definitive pathology in 24 (33 %) patients, of which 9 (38 %) were extraregional and 15 (63 %) regional. Conclusions EUS-TA may be of value in patients with potentially resectable pCCA based on preoperative cross-sectional imaging, regardless of lymphadenopathy at cross-sectional imaging. A prospective study in which a comprehensive EUS investigation with LN assessment and EUS-TA of LNs is performed routinely should confirm this promise.

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U2 - 10.1055/a-2005-3679

DO - 10.1055/a-2005-3679

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C2 - 36741342

SN - 2364-3722

VL - 11

SP - E162-E168

JO - Endoscopy International Open

JF - Endoscopy International Open

IS - 2

ER -

Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making

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