Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma

William R. Jarnagin, Wilbur Bowne, David S. Klimstra, Leah Ben-Porat, Kevin Roggin, Karina Cymes, Yuman Fong, Ronald P. DeMatteo, Michael D'Angelica, Jonathan Koea, Leslie H. Blumgart, William Chapman, Steven C. Stain, Henry A. Pitt, Alan W. Hemming, Reid B. Adams, Bryan M. Clary

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The current study compares outcome after resection of papillary hilar cholangiocarcinoma to that of the more common nodular-sclerosing subtype. Methods: Clinical, radiologic, histopathologic, and survival data on all patients with hilar cholangiocarcinoma were analyzed. Resected tumors were reexamined and classified as nodular-sclerosing (no component of papillary carcinoma) or papillary (any component of papillary carcinoma); for papillary tumors, the proportion of invasive carcinoma present was determined. Differences in the clinical behavior and histopathologic features of nodular-sclerosing and papillary tumors were assessed. Results: From January 1991 to November 2003, 279 patients were evaluated, 154 men (55.2%) and 125 women (44.8%), with a mean age of 65.4 ± 0.7 years (median = 68, range 23-87 years). Of the 215 patients explored, 106 (49.5%) underwent a complete gross resection. An en bloc partial hepatectomy (n = 87) and an RO resection (n = 82) were independent predictors of favorable outcome. Operative mortality was 7.5% but was 2.8% over the last 4 years of the study, and there were no operative deaths in the last 33 consecutive resections. Twenty-five resected tumors (23.6%) contained a papillary component: 12 were minimally or noninvasive (<10% invasive cancer) and 13 had an invasive component ranging from 10% to 95% (≥10%). Patients with papillary and nodular-sclerosing tumors had similar demographics, operative procedures, and proportion of RO resections. By contrast, papillary tumors were significantly larger, more often well-differentiated, and earlier stage. Disease-specific survival after resection of papillary tumors (55.7 months) was greater than after resection of nodular-sclerosing lesions (33.5 months, P = 0.013). The papillary phenotype was an independent predictor of survival, although the benefit was more pronounced for less invasive tumors. Conclusions: The presence of a component of papillary carcinoma is more common than previous reports have suggested and is an important determinant of survival after resection of hilar cholangiocarcinoma.

Original languageEnglish (US)
Pages (from-to)703-714
Number of pages12
JournalAnnals of surgery
Volume241
Issue number5
DOIs
StatePublished - May 2005

ASJC Scopus subject areas

  • Surgery

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