Accuracy and limitations of preoperative assessment of longitudinal spread of perihilar cholangiocarcinoma

Objective: Although surgical resection offers the only chance of cure of perihilar cholangiocarcinoma and R1 resection has a poor prognosis, there is no consensus on optimal preoperative assessment of its longitudinal spread. We aimed to establish the optimal means of achieving this goal.Methods: This was a retrospective, single-center study of 61 patients who had undergone multi-detector row computed tomography, endoscopic retrograde cholangiography, intraductal ultrasonography, and mapping biopsy prior to resection of perihilar cholangiocarcinomas in our institute from January 2010 and December 2021.Results: The most accurate single methods for assessing longitudinal spread were intraductal ultraso-nography and mapping biopsy (both 72.1%). A combination of all four assessment methods was accurate in 51 (83.6%) of our patients. Independent risk factors for inaccuracy were BismutheCorlette Type IV and high histologic-grade tumors. The R0 resection rate was higher with accurate than inaccurate assess-ments (90.2% vs. 30.0%, P < 0.001). R0 resection was associated with significantly better relapse-free survival than R1 resection (P 1/4 0.006). However, overall survival did not differ between these groups.Conclusion: Preoperative assessment of longitudinal spread of perihilar cholangiocarcinomas by four different modalities is optimal, achieving 83.6% accuracy and a 90.2% R0 resection rate.(c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Automated summary

This study aimed to determine the optimal preoperative assessment methods for the longitudinal spread of perihilar cholangiocarcinoma. Intraductal ultrasound and mapping biopsy were found to be the most accurate single assessment methods, and a combination of all four methods achieved high accuracy. The accuracy of assessment was associated with the R0 resection rate, and R0 resection was associated with better relapse-free survival compared to R1 resection. Overall survival did not differ between these groups.