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Hepatic resection and transplantation for peripheral cholangiocarcinoma

Casavilla, FA and Marsh, JW and Iwatsuki, S and Todo, S and Lee, RG and Madariaga, JR and Pinna, A and Dvorchik, I and Fung, JJ and Starzl, TE (1997) Hepatic resection and transplantation for peripheral cholangiocarcinoma. Journal of the American College of Surgeons, 185 (5). 429 - 436. ISSN 1072-7515

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Abstract

Background: Recent publications have questioned the role of orthotopic liver transplantation (OLT) in treating advanced or unresectable peripheral cholangiocarcinoma (Ch-Ca). Study Design: We reviewed our experience with Ch- Ca to determine survival rates, recurrence patterns, and risk factors in 54 patients who underwent either hepatic resection or OLT between 1981 and 1994. Liver transplantation was performed in patients with unresectable tumors (n = 12) and in those with advanced cirrhosis (n = 8). There were 33 women (61%) and 21 men (39%), with a mean age of 54.3 years. The median followup period was 6.8 years. Prognostic risk factors were analyzed by univariate and multivariate analyses. Results: Mortality within 30 days was 7.4%. Overall patient and tumor-free survival rates were 64% and 57% at 1 year, 34% and 34% at 3 years, and 26% and 27% at 5 years after operation. Thirty-two patients (59.3%) experienced tumor recurrence. Univariate analysis revealed that multiple tumors, bilobar tumor distribution, regional lymph node involvement, presence of metastasis, positive surgical margins, and advanced pTNM stages were significant negative predictors of both tumor-free and patient survival. Multivariate analysis revealed that positive margins, multiple tumors, and lymph node involvement were independently associated with poor prognosis. When patients with these three negative pred ictors were excluded, the patient survivals at 1, 3, and 5 years were 74%, 64%, and 62%, respectively. Conclusions: Both hepatic resection and OLT are effective therapies for Ch- Ca when the tumor can be removed with adequate margins, the lesion is singular, and lymph nodes are not involved.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Casavilla, FA
Marsh, JW
Iwatsuki, S
Todo, S
Lee, RG
Madariaga, JR
Pinna, A
Dvorchik, I
Fung, JJ
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 17 November 1997
Date Type: Publication
Journal or Publication Title: Journal of the American College of Surgeons
Volume: 185
Number: 5
Page Range: 429 - 436
DOI or Unique Handle: 10.1016/s1072-7515(97)00088-4
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 1072-7515
Other ID: uls-drl:31735062127349, Starzl CV No. 2013
Date Deposited: 08 Apr 2010 17:34
Last Modified: 18 Oct 2017 06:55
URI: http://d-scholarship.pitt.edu/id/eprint/5399

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