IS TYPE IV BISMUTH-CORLETTE PERIHILAR CHOLANGIOCARCINOMA A REAL CONTRAINDICATION FOR CURATIVE INTENT SURGICAL RESECTION? COMPARISON OF TYPE IV VS. TYPES I-II-III BISMUTH-CORLETTE PERIHILAR CHOLANGIOCARCINOMA IN A SINGLE TERTIARY REFERRAL CENTER
Tommaso Campagnaro*, Andrea Ruzzenente, Fabio Bagante, Simone Conci, Giacomo Di Filippo, Serena Manfreda, Raffaele Ziello, Calogero Iacono, Alfredo Guglielmi
Department of Surgery, University of Verona, Verona, Italy
Background: Even though the newly published AJCC 8th edition for staging perihilar cholangiocarcinoma (PH-CCA) removed the Bismuth-Corlette (BC) Type IV as a criteria for stage T4 and in Eastern series the prognosis of PH-CCA patients has not been associated with the BC classification, in the Western countries the surgical indication for BC Type IV PH-CCA patients is still under debate.
For this reason, we sought to compare the outcomes of BC Type IV patients versus BC Type I-II-IIIa-IIIb patients after curative intent surgical resection.
Methods: In this retrospective single center analysis, 111 patients who underwent curative intent surgery for PHC between January 1990 and December 2016 were included. Patients were categorized in two groups according to tumor extension along intrahepatic bile ducts, as defined by Bismuth-Corlette classification: group 1 (BC type I-II-IIIa-IIIb) and group 2 (BC type IV). Short- and long-term outcomes were compared between the two groups
Results: Among the 111 patients included in the analysis, 64 (58%) and 47 (42%) patients were in group 1 (BC type I-II-IIIa-IIIb) and group 2 (BC type IV), respectively. While there was no difference in terms of age, gender, and incidence of cirrhosis comparing the two groups (all p>0.05), patients in group 2 underwent more frequently preoperative biliary drainage (group 1, 75% vs. group 2, 93%; p=0.022) and portal vein embolization (group 1, 0% vs. group 2, 7%; p=0.035). Moreover, CA 19.9 serum level resulted higher in group 2 (mean CA 19.9, 957 U/L) than in group 1 (mean CA 19.9, 252 U/L; p=0.025). Conversely, incidence of lymphadenectomy, negative surgical margin, and positive lymph nodes did not significantly differ between group 1 and group 2 (all p>0.2). Postoperatively, patients in group 1 and group 2 had similar length of stay (median LoS: group 1, 8 days vs. group 2, 8 days; p=0.22), incidence of sever (Clavien-Dindo ≥3) and overall complications (sever complications: group 1, 25% vs. group 2, 30%; overall complications: group 1, 41% vs. group 2, 49%; both p>0.3). Of note, OS and DFS were not statistically different comparing group 1 and group 2 patients (mean OS: group 1, 26 months vs. group 2, 30 months; mean DFS: group 1, 21 months vs. group 2, 24 months; both p>0.4).
Discussion: Both short- and long-term outcomes resulted comparable between BC type IV and types I-II-IIIa-IIIb. Surgery should be considered as a curative intent treatment for patients with BC type IV PH-CCA when technically resectable.
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