Tumor-Associated Unilateral Portal Vein Occlusion Is Associated with Impaired Oncological Outcome in Perihilar Cholangiocarcinoma

Abstract

Introduction: While a certain degree of tumor infiltration of the portal vein is common in patients scheduled for surgery with perihilar cholangiocarcinoma (pCCA), complete tumor-associated portal vein occlusion (PVO) is less frequently observed and occasionally considered as contradiction for surgery. Therefore, the aim of this study was to unravel the impact of PVO on perioperative and oncological outcome in pCCA patients undergoing curative-intent liver resection. Methods: Between 2010 and 2019, 127 patients with pCCA underwent surgery at our hepatobiliary unit of which 17.3% (22/127) presented with PVO. Extensive group comparisons were conducted and the association of cancer-specific (CSS) and disease-free survival (DFS) with PVO and other clinico-pathological characteristics were assessed using Cox regression models. Results: Patients without PVO showed a median CSS of 65 months (3-year-CSS=64%, 5-year-CSS=53%) compared to 31 months (3-year-CSS=43%, 5-year-CSS=17%) in patients with PVO (p=0.025 log rank). Further, patients with PVO did display significant perioperative mortality (22.7%, 5/22) compared to patients without PVO (14.3%, 15/105, p=0.323). PVO (CSS: HR=5.25, p=0.001; DFS: HR=5.53, p=0.001) was also identified as independent predictors of oncological outcome. Conclusions: This study identifies tumor-associated PVO as an important prognostic marker playing a role in inferior oncological outcome in patients with pCCA. As PVO is also associated with notable perioperative mortality, surgical therapy should be considered carefully in pCCA patients.