Archives of Surgery

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ISSN / EISSN : 02725533 / 15383644
Current Publisher: American Medical Association (AMA) (10.1001)
Total articles ≅ 22,529
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Archives of Surgery, Volume 147; doi:10.1001/2013.jamasurg.202

Archives of Surgery, Volume 147; doi:10.1001/archsurg.147.12.1072

Archives of Surgery, Volume 147; doi:10.1001/archsurg.2011.2032b

Archives of Surgery, Volume 147; doi:10.1001/archsurg.2011.2230b

Dario Ribero, Antonio Daniele Pinna, A. Guglielmi, Antonio Ponti, Gennaro Nuzzo, Stefano Maria Giulini, Luca Aldrighetti, Fulvio Calise, Giorgio E. Gerunda, Mariano Tomatis, et al.
Archives of Surgery, Volume 147; doi:10.1001/archsurg.2012.1962

Abstract:
OBJECTIVES To examine the outcomes of a hepatectomy for intrahepatic cholangiocarcinoma (IHC) and to clarify the prognostic impact of a lymphadenectomy and the surgical margin. Large series of patients who were surgically treated for IHC are scarce. Thus, prognostic factors and long-term survival after resection of IHC remain uncertain. DESIGN Prospective study of patients who were surgically treated for IHC. Clinicopathologic, operative, and long-term survival data were analyzed. SETTING Prospectively collected data of all consecutive patients with pathologically confirmed IHC who had undergone liver resection with a curative intent at 1 of 16 tertiary referral centers were entered into a multi-institutional registry. PATIENTS All consecutive patients who underwent a hepatectomy with a curative intent for IHC (1990-2008) were identified from a multi-institutional registry. RESULTS A total of 434 patients were included in the analysis. Most patients underwent a major or extended hepatectomy (70.0%) and a systematic lymphadenectomy (62.2%). The incidence of lymph node metastases (overall, 36.9%) increased with increased tumor size, with 24.4% of patients with a small IHC (diameter ≤3 cm) having N1 disease. Almost one-third of patients required an additional major procedure to obtain a R0 resection in 84.6% of the cases. In these patients, the median time of survival was 39 months, and the 5-year survival rate was 39.8%. Lymph node metastases (hazard ratio, 2.21; P < .001), multiple tumors (hazard ratio, 1.50; P = .009), and an elevated preoperative cancer antigen 19.9 level (hazard ratio, 1.62; P = .006) independently predicted an adverse prognosis. Conversely, survival was not influenced by the width of a negative resection margin (P = .61). The potential survival benefit of a lymphadenectomy was assessed with the therapeutic value index, which was calculated to be 5.9 points. CONCLUSIONS Survival rates after a hepatectomy with a curative intent for IHC at tertiary referral centers exceed the survival rates reported in most study series in single institutions, which strengthens the value of an aggressive approach to radical resection. Lymph node metastases and multiple tumors are associated with decreased survival rates, but they should not be considered selection criteria that prevent other patients from undergoing a potentially curative resection. Lymphadenectomy should be considered for all patients.
Nsikak J Umoh, Robert E H Khoo
Archives of Surgery, Volume 147; doi:10.1001/archsurg.2011.2230a 10.1001/archsurg.2011.2230b

Kensuke Adachi, Tomohito Minami
Archives of Surgery, Volume 147; doi:10.1001/archsurg.2011.2032a 10.1001/archsurg.2011.2032b

Kensuke Adachi, Tomohito Minami
Archives of Surgery, Volume 147, pp 1147-1147; doi:10.1001/archsurg.2011.2032a

The publisher has not yet granted permission to display this abstract.
Nsikak J. Umoh, Robert E. H. Khoo
Archives of Surgery, Volume 147, pp 1149-1149; doi:10.1001/archsurg.2011.2230a

The publisher has not yet granted permission to display this abstract.
Daniel Smith, Avni Chudgar, Barry Daly, Matthew Cooper
Archives of Surgery, Volume 147, pp 1114-1122; doi:10.1001/archsurg.2012.1466

The publisher has not yet granted permission to display this abstract.
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