Ann Hepatobiliary Pancreat Surg.  2018 Aug;22(3):216-222. 10.14701/ahbps.2018.22.3.216.

A retrospective review of correlative radiological assessment and surgical exploration for hilar cholangiocarcinoma

• Chua D
• Low A
• Koh Y
• Goh B
• Cheow PC
• Kam JH
• Teo JY
• Tan EK
• Chung A
• Ooi LL
• Chan CY
• Lee SY

• KMID: 2420610
• DOI: http://doi.org/10.14701/ahbps.2018.22.3.216

Abstract

BACKGROUNDS/AIMS
Hilar cholangiocarcinomas (HCCAs) are tumors that involve the biliary confluence; at present, radical surgery offers the only chance of long-term survival, but this can be challenging given the complexity of the hilar anatomy. Blumgart and Jarnagin described a preoperative staging system that incorporates the effect of local tumor extent and its impact on adjacent structures and that has been demonstrated to correlate better with actual surgical resectability. The primary aim of this study is to describe the correlation between preoperative Blumgart-Jarnagin staging and its correlation with surgical resectability.
METHODS
Patients who underwent surgical resection for hilar cholangiocarcinoma at Singapore General Hospital between January 1, 2002, and January 1, 2013, were identified from a prospectively maintained institutional database. All patients were staged based on the criteria described by Blumgart and Jarnagin. Correlation with surgical resectability was then determined.
RESULTS
A total of 19 patients were identified. Overall resectability was 57.8% (n=11). Patients with Blumgart-Jarnagin stage T1 had the highest rates of resectability at 80%; patients with stage T2 and T3 disease had resectability rates of 25% and 40% respectively. Median overall survival was 13.6 months.
CONCLUSIONS
The Blumgart-Jarnagin staging system is useful for predicting tumor resectability in HCCA.

Keyword

Klatskin; Blumgart-janargin; Resectability; Hilar cholangiocarcinoma; Pre-operative

MeSH Terms

Hospitals, General
Humans
Klatskin Tumor*
Prospective Studies
Retrospective Studies*
Singapore

Figure

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  Fig. 1 Blumgart-Jarnargin staging system. T1 disease refers to tumor involvement of the biliary confluence with unilateral extension to second-order biliary radicles; T2 disease refers to tumor involving the biliary confluence with unilateral extension to second-order biliary radicles and ipsilateral portal vein involvement or ipsilateral hepatic atrophy. T3 disease refers to tumor involving the biliary confluence with bilateral extension to second-order biliary radicles or unilateral extension to second-order biliary radicles with contralateral portal vein involvement or unilateral extension to second-order biliary radicles with contralateral hepatic lobar atrophy or main/bilateral portal vein involvement.

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  Fig. 2 Flow-chart demonstrating patient selection.

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