Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma

Stefan Buettner, David W.G. ten Cate, Fabio Bagante, Sorin Alexandrescu, Hugo P. Marques, Jorge Lamelas, Luca Aldrighetti, T. Clark Gamblin, Shishir K. Maithel, Carlo Pulitano, Georgios Antonios Margonis, Matthew J Weiss, Todd W. Bauer, Feng Shen, George A. Poultsides, J. Wallis Marsh, Jan N.M. IJzermans, Timothy M. Pawlik, Bas Groot Koerkamp

Research output: Contribution to journalArticle

Abstract

Background: Multiple tumor foci of intrahepatic cholangiocarcinoma (ICC) are often considered a contra-indication for resection. We sought to define long-term outcomes after resection of ICC in patients with multiple foci. Methods: Patients who underwent resection for ICC between 1990 and 2017 were identified from 12 major HPB centers. Outcomes of patients with solitary lesions, multiple lesions (ML), and oligometastases (OM) were compared. OM were defined as extrahepatic metastases spread to a single organ. Results: One thousand thirteen patients underwent resection of ICC. On final pathology, 185 patients (18.4%) had ML and 27 (2.7%) had OM. Median survival of patients with a solitary tumor was 43.2 months, while the median survival of patients with 2 tumors was 21.2 months; the median survival of patients with 3 or more tumors was 15.3 months (p < 0.001). Five-year survival was 43.3%, 28.0%, and 8.6%, respectively. The median survival of patients without OM was 37.8 months versus 14.9 months among patients with OM (p < 0.001); estimated 5-year survival was 39.3% and 10.6%, respectively. In multivariable analysis, the presence of two lesions was not an independent poor prognostic factor for OS (HR 1.19; 95%CI 0.90–1.57; p = 0.229). However, the presence of three or more tumors was an independent poor prognostic factor for OS (HR 1.97; 95%CI 1.48–2.64; p < 0.001). Conclusion: Resection of multiple liver tumors for patients with ICC did not preclude 5-year survival: in particular, estimated 5-year OS for resection of two tumors was 28.0%.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StatePublished - Jan 1 2019

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Cholangiocarcinoma
Survival
Neoplasms
Pathology
Neoplasm Metastasis

Keywords

  • Intrahepatic cholangiocarcinoma
  • Multiple tumor location
  • Prognostic staging
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Buettner, S., ten Cate, D. W. G., Bagante, F., Alexandrescu, S., Marques, H. P., Lamelas, J., ... Koerkamp, B. G. (2019). Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma. Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-019-04184-2

Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma. / Buettner, Stefan; ten Cate, David W.G.; Bagante, Fabio; Alexandrescu, Sorin; Marques, Hugo P.; Lamelas, Jorge; Aldrighetti, Luca; Gamblin, T. Clark; Maithel, Shishir K.; Pulitano, Carlo; Margonis, Georgios Antonios; Weiss, Matthew J; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Marsh, J. Wallis; IJzermans, Jan N.M.; Pawlik, Timothy M.; Koerkamp, Bas Groot.

In: Journal of Gastrointestinal Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Buettner, S, ten Cate, DWG, Bagante, F, Alexandrescu, S, Marques, HP, Lamelas, J, Aldrighetti, L, Gamblin, TC, Maithel, SK, Pulitano, C, Margonis, GA, Weiss, MJ, Bauer, TW, Shen, F, Poultsides, GA, Marsh, JW, IJzermans, JNM, Pawlik, TM & Koerkamp, BG 2019, 'Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma', Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-019-04184-2
Buettner, Stefan ; ten Cate, David W.G. ; Bagante, Fabio ; Alexandrescu, Sorin ; Marques, Hugo P. ; Lamelas, Jorge ; Aldrighetti, Luca ; Gamblin, T. Clark ; Maithel, Shishir K. ; Pulitano, Carlo ; Margonis, Georgios Antonios ; Weiss, Matthew J ; Bauer, Todd W. ; Shen, Feng ; Poultsides, George A. ; Marsh, J. Wallis ; IJzermans, Jan N.M. ; Pawlik, Timothy M. ; Koerkamp, Bas Groot. / Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma. In: Journal of Gastrointestinal Surgery. 2019.
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abstract = "Background: Multiple tumor foci of intrahepatic cholangiocarcinoma (ICC) are often considered a contra-indication for resection. We sought to define long-term outcomes after resection of ICC in patients with multiple foci. Methods: Patients who underwent resection for ICC between 1990 and 2017 were identified from 12 major HPB centers. Outcomes of patients with solitary lesions, multiple lesions (ML), and oligometastases (OM) were compared. OM were defined as extrahepatic metastases spread to a single organ. Results: One thousand thirteen patients underwent resection of ICC. On final pathology, 185 patients (18.4{\%}) had ML and 27 (2.7{\%}) had OM. Median survival of patients with a solitary tumor was 43.2 months, while the median survival of patients with 2 tumors was 21.2 months; the median survival of patients with 3 or more tumors was 15.3 months (p < 0.001). Five-year survival was 43.3{\%}, 28.0{\%}, and 8.6{\%}, respectively. The median survival of patients without OM was 37.8 months versus 14.9 months among patients with OM (p < 0.001); estimated 5-year survival was 39.3{\%} and 10.6{\%}, respectively. In multivariable analysis, the presence of two lesions was not an independent poor prognostic factor for OS (HR 1.19; 95{\%}CI 0.90–1.57; p = 0.229). However, the presence of three or more tumors was an independent poor prognostic factor for OS (HR 1.97; 95{\%}CI 1.48–2.64; p < 0.001). Conclusion: Resection of multiple liver tumors for patients with ICC did not preclude 5-year survival: in particular, estimated 5-year OS for resection of two tumors was 28.0{\%}.",
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AU - ten Cate, David W.G.

AU - Bagante, Fabio

AU - Alexandrescu, Sorin

AU - Marques, Hugo P.

AU - Lamelas, Jorge

AU - Aldrighetti, Luca

AU - Gamblin, T. Clark

AU - Maithel, Shishir K.

AU - Pulitano, Carlo

AU - Margonis, Georgios Antonios

AU - Weiss, Matthew J

AU - Bauer, Todd W.

AU - Shen, Feng

AU - Poultsides, George A.

AU - Marsh, J. Wallis

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AU - Pawlik, Timothy M.

AU - Koerkamp, Bas Groot

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N2 - Background: Multiple tumor foci of intrahepatic cholangiocarcinoma (ICC) are often considered a contra-indication for resection. We sought to define long-term outcomes after resection of ICC in patients with multiple foci. Methods: Patients who underwent resection for ICC between 1990 and 2017 were identified from 12 major HPB centers. Outcomes of patients with solitary lesions, multiple lesions (ML), and oligometastases (OM) were compared. OM were defined as extrahepatic metastases spread to a single organ. Results: One thousand thirteen patients underwent resection of ICC. On final pathology, 185 patients (18.4%) had ML and 27 (2.7%) had OM. Median survival of patients with a solitary tumor was 43.2 months, while the median survival of patients with 2 tumors was 21.2 months; the median survival of patients with 3 or more tumors was 15.3 months (p < 0.001). Five-year survival was 43.3%, 28.0%, and 8.6%, respectively. The median survival of patients without OM was 37.8 months versus 14.9 months among patients with OM (p < 0.001); estimated 5-year survival was 39.3% and 10.6%, respectively. In multivariable analysis, the presence of two lesions was not an independent poor prognostic factor for OS (HR 1.19; 95%CI 0.90–1.57; p = 0.229). However, the presence of three or more tumors was an independent poor prognostic factor for OS (HR 1.97; 95%CI 1.48–2.64; p < 0.001). Conclusion: Resection of multiple liver tumors for patients with ICC did not preclude 5-year survival: in particular, estimated 5-year OS for resection of two tumors was 28.0%.

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