Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Nov;28(12):7719-7729.
doi: 10.1245/s10434-021-09905-z. Epub 2021 May 6.

Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group

Andrea Ruzzenente  1 , Fabio Bagante  1 , Pim B Olthof  2   3 , Luca Aldrighetti  4 , Ruslan Alikhanov  5 , Matteo Cescon  6 , Bas Groot Koerkamp  2 , William R Jarnagin  7 , Silvio Nadalin  8 , Johann Pratschke  9 , Moritz Schmelzle  9 , Ernesto Sparrelid  10 , Hauke Lang  11 , Calogero Iacono  12 , Thomas M van Gulik  3 , Alfredo Guglielmi  1 ; Perihilar Cholangiocarcinoma Collaboration Group
Collaborators, Affiliations
Multicenter Study

Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group

Andrea Ruzzenente et al. Ann Surg Oncol. 2021 Nov.

Abstract

Background: Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database.

Methods: Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA.

Results: Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60).

Conclusions: In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Overall survival of Bismuth type 2 or 3 patients versus Bismuth type 4 patients.
Fig. 2
Fig. 2
Overall survival of Bismuth type 2 or 3 patients versus Bismuth type 4 N0R0 patients.
See this image and copyright information in PMC

Comment in

References

    1. DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245:755–762. doi: 10.1097/01.sla.0000251366.62632.d3. - DOI - PMC - PubMed
    1. Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci. 2010;17:449–454. doi: 10.1007/s00534-009-0209-0. - DOI - PubMed
    1. Mansour JC, Aloia TA, Crane CH, Heimbach JK, Nagino M, Vauthey JN. Hilar cholangiocarcinoma: expert consensus statement. HPB Oxford. 2015;17:691–699. doi: 10.1111/hpb.12450. - DOI - PMC - PubMed
    1. Ruzzenente A, Bagante F, Ardito F, et al. Comparison of the 7th and 8th editions of the American Joint Committee on Cancer Staging Systems for perihilar cholangiocarcinoma. Surgery. 2018;164:244–250. doi: 10.1016/j.surg.2018.03.012. - DOI - PubMed
    1. Wiggers JK, Groot Koerkamp B, Cieslak KP, et al. Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J Am Coll Surg. 2016;223(2):321.e1–331.e1. doi: 10.1016/j.jamcollsurg.2016.03.035. - DOI - PMC - PubMed

Publication types