Randomized Controlled Trial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2015; 7(12): 503-512
Published online Dec 15, 2015. doi: 10.4251/wjgo.v7.i12.503
Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand
Attapol Titapun, Ake Pugkhem, Vor Luvira, Tharatip Srisuk, Ongart Somintara, O-tur Saeseow, Anan Sripanuskul, Anongporn Nimboriboonporn, Bandit Thinkhamrop, Narong Khuntikeo
Attapol Titapun, Ake Pugkhem, Vor Luvira, Tharatip Srisuk, Ongart Somintara, O-tur Saeseow, Anan Sripanuskul, Anongporn Nimboriboonporn, Narong Khuntikeo, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Bandit Thinkhamrop, Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand
Attapol Titapun, Ake Pugkhem, Bandit Thinkhamrop, Narong Khuntikeo, CASCAP Program, Khon Kaen University, Khon Kaen 40002, Thailand
Attapol Titapun, Ake Pugkhem, Narong Khuntikeo, Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Author contributions: Titapun A and Pugkhem A are co-first authors and contributed equally to this work; Titapun A, Pugkhem A and Khuntikeo N designed the study; Titapun A, Pugkhem A, Luvira V, Srisuk T, Somintara O, Saeseow O, Sripanuskul A, Nimboriboonporn A and Khuntikeo N performed the research and acquired the data; Titapun A, Pugkhem A Thinkhamrop B and Khuntikeo N analyzed the data; Titapun A, Pugkhem A and Khuntikeo N drafted the manuscript; Titapun A, Pugkhem A and Khuntikeo N designed the study; Titapun A, Pugkhem A, Luvira V, Srisuk T, Somintara O, Saeseow O, Sripanuskul A, Nimboriboonporn A, Thinkhamrop B and Khuntikeo N contributed significantly to the revision of the manuscript.
Supported by Khon Kaen University through CASCAP and the National Research Council of Thailand through the Medical Research Network of the Consortium of Thai Medical Schools.
Institutional review board statement: The entire study was carried out in strict accordance with protocols approved by Institutional Ethics Committee, Khon Kaen University (Ethics Permit Number: 571283).
Clinical trial registration statement: There are no randomized trials to prove the benefit of chemotherapy in an adjuvant setting. This study was not designed to prove the benefit of chemotherapy but there is one retrospective study from our institute from the years 2009-2011 that may imply benefit of adjuvant chemotherapy.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at nkhuntikeo@gmail.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Narong Khuntikeo, MD, Department of Surgery, Faculty of Medicine, Khon Kaen University, Mittraphap 18 Alley, Nai Mueang, Mueang Khon Kaen District, Khon Kaen 40002, Thailand. nkhuntikeo@gmail.com
Telephone: +66-43-348393 Fax: +66-43-348393
Received: August 3, 2015
Peer-review started: August 4, 2015
First decision: September 14, 2015
Revised: September 27, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: December 15, 2015
Abstract

AIM: To examine survival outcomes of perihilar cholangiocarcinoma (PCCA) resection including mortality, morbidity and prognostic factors.

METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011.

RESULTS: There were 29 (19%) cases of intrahepatic CCA that involved hilar and 124 (81%) with hilar bile-duct cancer. R0 resection was carried out on 66 (43.1%) patients of whom 50 (32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6% (95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1.

CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.

Keywords: Perihilar cholangiocarcinoma, Thailand, Curative resection, Five-year survival, Prognostic factors

Core tip: Cholangiocarcinoma is usually fatal because detection most commonly occurs during late stage disease. Early detection leads to a substantially better survival outcome Thus, priority should be placed on early stage detection allowing curative radical surgery.