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Vascular resection for distal cholangiocarcinoma

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Abstract

Purpose

Vascular resection (VR) is extended surgery to attain a negative radial margin (RM) for distal cholangiocarcinoma (DCC). The present study explored the significance of VR for DCC, focusing on VR, RM, and findings suggestive of vascular invasion on multidetector-row computed tomography (MDCT).

Methods

Patients with DCC who underwent resection between 2002 and 2019 were reviewed.

Results

Among 230 patients, 25 received VR. The overall survival (OS) in the VR group was significantly worse than in the non-VR group (16.7% vs. 50.7% at 5 years, P < 0.001). Patients who underwent VR with a negative RM failed to show a better OS than those who did not undergo VR with a positive RM (19.7% vs. 35.7% at 5 years, P = 0.178). Of the 30 patients who were suspected of having vascular invasion on MDCT, 11 did not receive VR because the vessels were freed from the tumor; these patients had a significantly better OS (57.9% at 5 years) than those who underwent VR.

Conclusions

VR for DCC was associated with a poor prognosis, even if a negative RM was obtained. VR is not necessary for DCC when the vessels are detachable from the tumor.

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Data availability

The datasets generated and/or analyzed during this study are available from the corresponding author on reasonable request.

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Acknowledgements

The protocol for this research project was approved by a suitable institutional ethics committee and conformed to the provisions of the Declaration of Helsinki. The Institutional Review Board of Shizuoka Cancer Center approved the study (approval number J2020-135-2020-1-3).

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Ryusei Yamamoto, Teiichi Sugiura, Ryo Ashida, Katsuhisa Ohgi, Mihoko Yamada, Shimpei Otsuka & Katsuhiko Uesaka

  2. Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Takeshi Aramaki & Koiku Asakura

Authors
  1. Ryusei Yamamoto
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  2. Teiichi Sugiura
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  3. Ryo Ashida
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  4. Katsuhisa Ohgi
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  5. Mihoko Yamada
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  6. Shimpei Otsuka
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Correspondence to Teiichi Sugiura.

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Informed consent

Informed consent was substituted by the informed opt-out procedure because of the retrospective nature of the study, and anonymous clinical data were used for the analysis.

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Supplementary Information

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Supplementary file1 (DOCX 18 KB)

595_2022_2634_MOESM2_ESM.tiff

Supplementary file2 Supplementary Fig. 1 The overall survival according to the surgical procedure. PD pancreatoduodenectomy, HPD hepatopancreatoduodenectomy (TIFF 1944 KB)

595_2022_2634_MOESM3_ESM.tiff

Supplementary file3 Supplementary Fig. 2 The overall survival according to microscopic tumor invasion to the hepatic artery or portal vein in patients who underwent vascular resection (TIFF 1919 KB)

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Yamamoto, R., Sugiura, T., Ashida, R. et al. Vascular resection for distal cholangiocarcinoma. Surg Today 53, 899–906 (2023). https://doi.org/10.1007/s00595-022-02634-0

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