scholarly journals Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: A multi-institution analysis from the U.S. extrahepatic biliary malignancy consortium

2017 ◽  
Vol 117 (3) ◽  
pp. 363-371 ◽  
Author(s):  
Bradley A. Krasnick ◽  
Linda X. Jin ◽  
Jesse T. Davidson ◽  
Dominic E. Sanford ◽  
Cecilia G. Ethun ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Hilar Cholangiocarcinoma ◽  
Curative Resection ◽  
Biliary Malignancy ◽  
The U.S

Curative resection for hilar cholangiocarcinoma: Does adjuvant therapy impact overall survival? A multi-institution analysis from the U.S. Extrahepatic Biliary Malignancy Consortium.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 388-388
Author(s):  
Bradley Krasnick ◽  
Linda Jin ◽  
Jesse Davidson ◽  
Cecilia Grace Ethun ◽  
Timothy M. Pawlik ◽  
...  
Keyword(s):  
Overall Survival ◽  
Regression Analysis ◽  
Adjuvant Therapy ◽  
Hilar Cholangiocarcinoma ◽  
Curative Resection ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Biliary Malignancy ◽  
The Impact ◽  
The U.S

388 Background: Surgical resection is the cornerstone of curative therapy for localized hilar cholangiocarcinoma. However, the effect of adjuvant therapy (AT) on survival is unclear. We analyzed the impact of AT on overall survival (OS) in those patients undergoing curative resection for hilar cholangiocarcinoma. Methods: We reviewed 294 patients who underwent curative resections for hilar cholangiocarcinoma between 1998 and 2015 from ten institutions participating in the U.S Extrahepatic Biliary Malignancy consortium. We analyzed the impact of AT on the primary outcome of OS. Probability of OS was calculated in the method of Kaplan and Meier and analyzed using multivariate Cox regression analysis. Statistical significance was set at p≤0.05. Results: Mean age was 65 years. OS at 5 years was 16%. A total of 146 patients (50%) received AT. Of these patients, 44 patients underwent solely chemotherapy, 5 underwent only radiation therapy (XRT), and 97 underwent combined therapy. On univariate analysis, patients who received AT and those who did not had similar demographic and preoperative features, with the major difference being in the rate of lymph node (LN) positive disease (50% AT group vs. 19% no AT group, p<0.01). In a multivariate Cox regression analysis, AT conferred a significant protective effect on OS (HR 0.578, p<0.01, 95% CI 0.38-0.86), even when adjusting for age, tumor size, R0 resection status, ASA classification, and LN positivity (Table). Conclusions: AT is associated with improved OS in resected hilar cholangiocarcinoma. This association remains even after adjusting for poor prognostic features. We acknowledge that there is an inherent selection bias when looking at those who underwent AT, and thus future prospective randomized trials are needed. [Table: see text]

The effect of postoperative morbidity on long-term survival after curative resection for extra-hepatic biliary tumors: A multi-institution analysis from the U.S. Extrahepatic Biliary Malignancy Consortium.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 435-435
Author(s):  
Linda Jin ◽  
Bradley Krasnick ◽  
Jesse Davidson ◽  
Cecilia Grace Ethun ◽  
Timothy M. Pawlik ◽  
...  
Keyword(s):  
Curative Resection ◽  
Cox Regression ◽  
Complication Rates ◽  
Term Survival ◽  
Long Term Survival ◽  
Curative Therapy ◽  
Biliary Malignancy ◽  
The Impact ◽  
The U.S

435 Background: Surgical resection is the cornerstone of curative therapy for extrahepatic biliary tumors (EHBTs) Postoperative complications (POCs) can negatively impact survival after oncologic resection. We evaluated the impact of POCs on survival after resection of EHBTs. Methods: We analyzed 914 patients from ten institutions of the U.S. Extrahepatic Biliary Malignancy Consortium who underwent curative resection for gallbladder adenocarcinoma (n=389), hilar (n=295) and distal (n=294) cholangiocarcinoma between 1998 and 2015. POCs were graded using the modified Clavien-Dindo system. Overall survival (OS) probabilities were estimated using the method of Kaplan and Meier and analyzed using multivariate Cox regression. Results: Median follow-up was 20 months. The median age was 66 years, and the overall complication rate was 54%. Complication rates were significantly higher in patients with distal or hilar cholangiocarcinoma (62%) when compared with gallbladder cancer (41%, p<0.001). For all cancer types, patients who experienced POCs had lower 5-year OS when compared with those who did not (18% vs 28%, p<0.001). On multivariate Cox regression, POC remained an independent predictor for decreased OS (HR 1.5, 95% CI 1.3-1.9, p<0.001; Table). Among patients who experienced POCs, survival did not differ by greatest Clavien grade of complication experienced (p=0.89), however patients who had 2 or more POCs did have decreased long term survival when compared with patients with only a single POC (HR 1.5, 95% CI 1.2-1.8, p=0.001). Conclusions: POCs adversely affect long-term outcomes after curative resection for extra-hepatic biliary tumors. While any complication grade did not have a significant impact on long-term survival, increasing number of POCs did significantly worsen the prognosis for OS. [Table: see text]

scholarly journals A Case of Hilar Cholangiocarcinoma Undergoing Curative Resection after Approximately One Year of Multidisciplinary Therapy

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S339-S340
Author(s):  
M. Hamano ◽  
S. Katagiri ◽  
M. Oota ◽  
S. Onizawa ◽  
Y. Niwa ◽  
...  
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Curative Resection ◽  
Multidisciplinary Therapy ◽  
One Year

Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16083-e16083
Author(s):  
Yung Lee ◽  
Yasith Samarasinghe ◽  
Michael H Lee ◽  
Luxury Thiru ◽  
Yaron Shargall ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Survival Benefit ◽  
Locoregional Recurrence ◽  
Curative Resection ◽  
Meta Analysis ◽  
Distant Recurrence ◽  
Curative Esophagectomy

e16083 Background: While neoadjuvant therapy followed by esophagectomy is the standard of care for locally advanced esophageal cancer, the role of adjuvant therapy is uncertain. As such, this review aims to analyze esophageal cancer patients who previously underwent neoadjuvant therapy followed by a curative resection (negative margins) to determine whether additional adjuvant therapy is associated with improved survival outcomes. Methods: MEDLINE, EMBASE, and CENTRAL databases were searched up to August 2020 for studies comparing patients with esophageal cancer who underwent neoadjuvant therapy and curative resection with and without adjuvant therapy. Primary outcome was overall survival (OS), and secondary outcomes were disease-free survival (DFS), locoregional recurrence, and distant recurrence at 1 and 5-years. Random effects meta-analysis was conducted where appropriate. Grading of recommendations, assessment, development, and evaluation (GRADE) was used to assess the certainty of evidence. Results: Ten studies involving 6,462 patients were included. 6,162 (95.36%) patients from 7 studies received adjuvant chemotherapy, whereas 296 (4.58%) patients from 3 studies underwent either adjuvant radiotherapy or chemoradiotherapy. When compared to patients who received neoadjuvant therapy and esophagectomy alone, adjuvant therapy groups experienced a significant overall survival benefit by 48% at 1-year (RR 0.52, 95%CI 0.41-0.65, P < 0.001, moderate certainty). This reduction in mortality was consistent at long-term 5-year follow-up (RR 0.91, 95%CI 0.87-0.96, P < 0.001, moderate certainty). Subgroup analysis on pathologic node positive patients demonstrated a consistent survival benefit at 1-year (RR 0.57, 95% CI 0.42-0.77, P < 0.001, moderate certainty) and 5-year (RR 0.89 95%CI 0.84-0.95, P < 0.001, moderate certainty). While adjuvant therapy presented no benefit for the T0-2 stage subgroup, patients with T3-4 disease experienced a significant reduction in mortality with the addition of adjuvant therapy at both 1-year (RR 0.51, 95% CI 0.41-0.63, P < 0.001, moderate certainty), and 5-years (RR 0.91, 95% CI 0.85-0.97, P = 0.005, moderate certainty). Due to incomplete reporting, the added benefit of adjuvant therapy was uncertain regarding DFS, locoregional recurrence, and distant recurrence. Conclusions: Adjuvant therapy after neoadjuvant treatment and curative esophagectomy provides improved OS at 1 and 5 years, but the benefit for DFS and locoregional/distant recurrence was uncertain due to limited reporting of these outcomes.

Application of Portal Parenchyma–Enterostomy after High Hilar Resection for Bismuth Type IV Hilar Cholangiocarcinoma

2010 ◽  
Vol 76 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Yu Cheng ◽  
Yuxin Chen ◽  
Hongqiang Chen
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Curative Resection ◽  
R0 Resection ◽  
Extended Hepatectomy ◽  
Liver Lobe ◽  
Type Iv ◽  
Average Survival ◽  
Serum Aspartate Aminotransferase ◽  
Complications And Mortality

For the surgical treatment of Bismuth Type IV hilar cholangiocarcinoma, it is difficult to achieve curative resection (R0 resection) with restrictive excision (local resection and parenchyma-preserving liver resection) as a result of the complexity and difficulty in biliary reconstruction. Extended hepatectomy with vessel resection can improve the rate of curative resection, but it can also give rise to postoperative complications and mortality. We proposed a high hilar resection and portal parenchyma–enterostomy method to improve the surgical procedure. Eleven patients with Bismuth IV hilar cholangiocarcinoma underwent high hilar resection (resection for tumors in bile ducts and 1 cm above the tumors including segments IVb, V, and part of the caudate liver lobe) and the biliary tract was reconstructed through a portal parenchyma–enterostomy. Biliary radicles were not ligated but were drained into the “bile lake.” No cases of perioperative death were observed. Four weeks after surgery, patients’ serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin were decreased evidently. The average survival was 25.3 months. In conclusion, the portal parenchyma–enterostomy procedure can be performed with increased curative rate and reduced parenchyma resection, extending the survival time of patients and improving patients’ quality of life.

The prognosis after curative resection of gallbladder cancer with hilar invasion is similar to that of hilar cholangiocarcinoma

2011 ◽  
Vol 19 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Yuya Nasu ◽  
Eiichi Tanaka ◽  
Satoshi Hirano ◽  
Takahiro Tsuchikawa ◽  
Kentaro Kato ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Hilar Cholangiocarcinoma ◽  
Curative Resection

Outcomes of adjuvant chemoradiotherapy after a radical gastrectomy and D2 node dissection for gastric adenocarcinoma in INEN (Lima, Peru).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 150-150
Author(s):  
Paola Catherine Montenegro ◽  
Lourdes Lopez ◽  
Shirley Quintana ◽  
Luis Augusto Casanova ◽  
Victor Castro ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Gastric Adenocarcinoma ◽  
Curative Resection ◽  
Standard Treatment ◽  
Adjuvant Chemoradiotherapy ◽  
Rank Test ◽  
D2 Lymphadenectomy ◽  
Risk Of Death ◽  
Node Positive

150 Background: Adjuvant chemoradiotherapy is the standard treatment in Western countries in gastric cancer patients submitted to curative resection. INT 0116 pivotal trial established adyuvant chemoradiation as the standar care for resected high risk adenocarcionoma of the stomach in US however was hampered by suboptimal surgery. There is controversial data about efficacy of this adjuvant therapy in patients who have undergone D2 lymphadenectomy predominantly. In our hospital D2 lymphadenectomy is standar surgery for gastric cancer. Methods: Retrospective study with gastric adenocarcinoma patients stage II to IV M0 who underwent curative resection at Instituto Nacional de enfermedades Neoplasicas Lima- Peru between 2001 and 2006 Standard treatment at institution is D2 lymphadenectomy. Chemoradiotherapy according to INT 0116 was given like adjuvant therapy. Survival curves were calculated according to Kaplan-Meier method and compared with log-rank test. Multivariate analysis of prognostic factors related to survival was performed by Cox proportional hazards model adjusted for age, stage and adjuvant chemoradiotherapy. Results: 84 patients were included 60.3% male and 39.3% female. Median age was 40.5 years old. The patologic stage were T1-T2 (12.3%), T3-T4 ( 50% ), N0-N1 (10.7%), N2-N3 (89.3%). D2 lymphadenectomy was performed in all patients. The 3-year DFS was 17% and 3-year overall survivall was 23.9% years.However when we analized by subgroups the overal survival was significantly longer in group N1 ( 61%) and N2 (58.9%) that N3 (18.3%) and DFS were N1 (60%), N2 (55%) and N3 (16.3%). Conclusions: Adjuvant chemoradiotherapy decreased risk of death and relapse in patients with node positive N1-N2 , who underwent curative resection with D2 lymphadenectomy, but recurrence was most frecuent in N3 node positive, maybe is necesary improve the chemotherapy in this group of patientes for dicrease the rate of relapse.

Sign in / Sign up

Export Citation Format

Share Document