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Surgical and combined treatment for patients with cholangiocarcinoma: the experience of FSBIтезисы доклада Тезисы
- Автор: Polyakov A.N.
- Сборник: ESMO 21st World Congress on Gastrointestinal Cancer
- Том: 30
- Тезисы
- Год издания: 2019
- Издательство: Oxford University Press
- Местоположение издательства: United Kingdom
- Аннотация: IntroductionBackground and Aims: to improve the results of surgical and combined treatment of patients (pts) with cholangiocarcinoma (CCA)MethodsFrom 1998 to 2017 a total of 263 pts with bile duct cancer underwent surgery. Of the 128 liver resections performed for pts with intrahepatic cholangiocarcinoma (iCCA), 101 of them were extensive (78.9%) and 27 were slight (21.1%). In addition to liver resection, extrahepatic bile duct cutting was performed in 11 pts (8.6%), vascular resection in 6 cases (4.7%), and 19 pts underwent resection of other organs (14.8%). The III-IV stages were observed in 83.6% (n = 107). Lymph node (LN) involvement was suggested in 37 pts (28.9%). R0 resection rate was 81.3% (n = 104). All pts with distal bile duct cancer (n = 77) underwent Whipple-procedure. The portal vein was resected in 8 pts (10.4%). The I-II stages were more common at 77.2% (n = 60). R0 resection was 83.1% (n = 64). LNl involvement was suggested in 18 pts (23.4%). There were 58 pts with hilar CCA. The III-IV stages (TNM) were prevalent at 72,4% (n = 42). The III-IV (Bismut) stages were observed in 87.9% (n = 51). Most pts with Klatskin tumor (89.7%, n = 52) underwent liver resection with extrahepatic bile duct resection. R0 resection rate was 82.7%. The bile duct resections alone were performed in 6 cases (10.3%). R0 resection was achieved in 1 case only (16.7%). Portal vein resection was required in 16 pts (27.9%). LN positive revealed in 22 pts (37.9%). Among all pts with CCA, 90 (34.2%) pts received postoperative chemotherapy, in 74 cases after R0 resection.ResultsPostoperative complications occurred in 172 cases (65.4%) and postoperative mortality rate was 7.2% (n = 19). Five- and ten-year survival rates were 36.6% and 17.7%, respectively. Median OS was 30 months (mo). LT results were significantly better in the R0-resection group than in the R1-R2 group (the median OS was 37 mo and 20 mo, respectively, P = .01). The median OS in the group with LN metastasis was 26 mo, compared with 46 mo in the group with negative LN (P = .016). Adjuvant chemotherapy (capecitabine monotherapy or GemCap) improved LT results in the R0 resection group: the median OS in the group with postoperative chemotherapy was 46 mo, the median OS in the surgery group was 30 mo (P = .02). Five-year survival rates were 49.6% and 33%, respectively. Multiple lesions (median is 40 mo vs 64, P = .22) and jaundice (median is 38 mo vs 55, P = .4) did not show adverse prognostic value in the group of pts with iCCA.ConclusionIt is important to strive to perform a radical resection with sufficient LN dissection and, if necessary, resection of nearby involved structures. LN dissection must be routinely used. The standard volume of surgery for a Klatskin tumor is resection of bile ducts in combination with extensive liver resection. In the case of iCCA, multiple liver lesions and extrahepatic bile duct involvement are not contraindications to operation. Adjuvant chemotherapy significantly improves long-term outcomes.
- Добавил в систему: Поляков Александр Николаевич