%0 Journal Article
%T Prognostic Impact of Preoperative Imaging Parameters on Resectability of Hilar Cholangiocarcinoma
%A Anthony T. Ruys
%A Olivier R. Busch
%A Erik A. Rauws
%A Dirk J. Gouma
%A Thomas M. van Gulik
%J HPB Surgery
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/657309
%X Objectives. To evaluate, in hilar cholangiocarcinoma (HCCA), the prognostic impact of specific preoperative radiologic parameters on resectability, metastases, and yield of laparoscopy, and to evaluate the currently used staging systems. Methods. Consecutive patients with HCCA presenting in our center from January 2003 through August 2010 were evaluated. Suspicion on lymph node metastasis, portal vein and hepatic artery involvement, lobar atrophy, and proximal extent of ductal invasion was scored. The prognostic value of these parameters for predicting resectability, yield of diagnostic laparoscopy, likelihood of metastatic disease, R0 resection, and survival was assessed. The Bismuth-Corlette classification and MSKCC staging system were evaluated. Results. Of all 289 evaluated patients, 158 patients (55%) had unresectable disease based on cross-sectional imaging studies or diagnostic laparoscopy; 131 patients (45%) underwent exploration. 83 patients (64%) underwent resection, of whom 67 (87%) had a radical (R0) resection. Suspicious lymph nodes and involvement of the hepatic artery were important prognostic factors for resectability. Predictive power of the evaluated staging systems was limited. Conclusions. Current staging systems predict resectability, but there is room for improvement. Hepatic artery involvement and nodal status might be important factors for prediction of resectability and should be considered in future staging systems. 1. Introduction Hilar cholangiocarcinoma (HCCA), or Klatskin tumor, is a rare cancer arising at the confluence of the right and left hepatic ducts. Radical surgery is still the only curative treatment, although this can only be performed in a minority of patients. Many different imaging techniques are used for staging of HCCA. Nonetheless, only 50¨C60% of patients who are surgically explored are ultimately amenable to a potentially curative resection, due to peritoneal, nodal, or liver metastases, as well as locally advanced disease [1]. Already in 1975 the Bismuth-Corlette (BC) classification was proposed [2], which has been modified in 1992 [3]. This classification system is based on proximal, ductal extent of the tumor. Since the BC classification was not able to predict resectability [4, 5], the Memorial Sloan-Kettering Cancer Center (MSKCC) developed a new presurgical T-staging system in 1998 [6] that also took into account portal vein involvement, lobar atrophy, and ductal extent of the tumor. This staging system was further modified in 2001 [7]. Lastly, in 2009 the TNM staging system for malignant tumors was
%U http://www.hindawi.com/journals/hpb/2013/657309/