P-73 Survival outcomes of surgical resection in perihilar cholangiocarcinoma in endemic area of O. Viverrini, Thailand

Abstract

Perihilar cholangiocarcinoma is an intractable malignancy and still remain the most challenge for surgeon. This study aims to investigate survival outcomes and prognostic factors in perihilar cholangiocarcinoma patient receiving surgical treatment in single center in Thailand, endemic area of O. Viverrini. From October 2013 to December 2018, 240 consecutive patients with perihilar cholangiocarcinoma underwent surgical exploration with or without adjuvant treatment at Sunpasitthiprasong hospital were retrospectively reviewed from medical recording system. The clinicopathological parameters and surgical outcomes were extracted. Patients were divided into two groups: unresectable and resectable group. The restricted mean survival time between two groups were analyzed. Factors associated with overall survival in resectable group were explored with multivariable Cox regression analysis. Of the 240 patients, 201 (83.75%) were received surgical resection. The survival outcomes of resectable group was better than unresectable group significantly. The restricted mean survival time difference were 0.5 (95%CI 0.22-0.82) months, 1.8 (95%CI 1.15-2.49) months, 4.7 (95%CI 3.58-5.87) months, and 9.1 (95%CI 7.40-10.78) months at four landmark time points of 3, 6, 12 and 24 months, respectively. The incidence of major complications and 90-day mortality in resectable group were 35.82% and 11.44%, respectively. Bismuth type IV, vascular resection, positive resection margin, lymph node metastasis, and distant metastasis were all predictive factors for long-term survival in univariable analysis. However, multivariable analysis revealed that Bismuth type IV (HR:4.43, 95%CI 1.853-10.599), positive resection margin (HR:4.24, 95%CI 1.741-10.342), and lymph node metastasis (HR:2.29, 95%CI 1.046-4.999) were all independent predictors of long-term survival. For pM0, R0 and pN0 patients, the median survival time was better than pM0, R1 or pN1/2 patients and pM0, R1 and pN1/2 patients (32.4, 10.4 and 4.9 months, respectively; p < 0.001). Surgical resection increased survival in perihilar cholangiocarcinoma. Bismuth type IV, positive resection margin and lymph node metastasis were independent factors for long-term survival. Patients with R0 and pN0 had a good prognosis, but those with R1/2 and/or pN1/2 had a bad prognosis. As a result, aggressive resection are essential.