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Is staging laparoscopy useful in the management of hilar and intra-hepatic cholangiocarcinoma? A U.K. tertiary referral centre experience
Electronic Poster Abstracts
e27
FP06-04 - Table
TYPE
A1
A2
B1
B2
Ex+RYHJ
C1
C2
D1
D2
TOTAL (%)
60
247
19
44
373 (82.7%)
38
38 (8.4%)
Ex+Hx+RYHJ Hx
24
11
LTx
3^
35 (7.8%)
3
3 (0.7%)
Post-OP Complications (Grade:n) PHLF
51 (11.3%) 2 (a:2)
Biliary leak
4 (a:4)
Pancreatic leak Intraperitoneal bleeding
2 (a:1, b:1)
1 (a:1)
3 (a:3)
5 (1.1%) 20 (4.4%)
9 (a:7, b:2)
2 (a:2)
5 (a:3, b:2)
5 (a)
1 (a)
2 (a:1, c:1)
8 (1.8%)
3#(a:2, c:1)
10 (2.2%)
4 (a:2, b:1, c:1)
[Treatment and outcomes of Each Type of CC]
The new classification system could serve as a common language for CC and standardize the surgical treatment which should be precisely tailored for each patient.
FP06-05 IS STAGING LAPAROSCOPY USEFUL IN THE MANAGEMENT OF HILAR AND INTRA-HEPATIC CHOLANGIOCARCINOMA? A U.K. TERTIARY REFERRAL CENTRE EXPERIENCE N. Bird1, M. Elmasry2, M. Kelly1, R. Jones2, A. Pieri3, T. Greenhalgh4, M. Elniel4, A. McKenna4, D. Ormesher4, S. Bird4, E. Wakeford4, A. Tufo4, S. Fenwick5, J. Evans2, G. Poston5, H. Malik5 and Liverpool Hepato-Biliary MRC GROUP 1 HPB Surgery, University Hospital Aintree, 2Liverpool University, 3Gateshead Queen Elizabeth Hospital, 4University Hospital Aintree, and 5Hepato-Biliary Surgery, University Hospital Aintree, United Kingdom Introduction: Staging laparoscopy is part of the routine management of cholangiocarcinoma for determining if there is occult intra-abdominal metastatic disease not discernible on cross-sectional imaging. The aim was to determine the utility of staging laparoscopy in a retrospective cohort of hilar and intra-hepatic cholangiocarcinoma patients at a large tertiary referral centre. Methods: A database of 110 cholangiocarcinoma patients undergoing staging laparoscopy over an 8 year period from June 2007 to June 2015 was retrospectively analysed. The efficacy of staging laparoscopy in terms of Yield, Positive-Predictive-Value, False-Discovery-Rate and Specificity of the test was then calculated. Patients Undergoing Laparoscopy
Patients Undergoing Laparotomy
Total Number of Patients
110
80
Male: Female
63:47
47:33
Disease Precludes Further Surgery
30
16
Peritoneal Mets
15
11
Intra-Hepatic Mets
2
6 (continued on next page)
HPB 2016, 18 (S1), e1ee384
(continued ) Patients Undergoing Laparoscopy
Patients Undergoing Laparotomy
Locally Advanced
6
8
Poor Liver Quality
4
0
Resection
0
64
[110 Laparoscoped Cholangiocarcinoma Patients]
Results: The Yield of laparoscopy precluding further surgery was 27.2% (30/110). The Positive-Predictive-Value of laparoscopy was 80% (64/80). The False-Discovery-Rate was 20% (1-PPV). The Specificity of laparoscopy was 65.2% (30/46). 42.3% of patients with peritoneal metastases proceeded to laparotomy. 47/64 (73.4%) resections had cholangiocarcinoma; 14/64 (21.3%) benign disease; 3/64 (4.7%) other tumours. Mean age 63.2 Conclusions: The high Positive-Predictive-Value of 80% indicates that staging laparoscopy is highly precise in confirming radiological resectable intra-hepatic and hilar cholangiocarcinoma. However, the relatively low Specificity 65.2% indicates that in borderline resectable cases laparoscopy’s utility is more limited.
FP06-06 PROPOSAL OF A NEW STAGING SYSTEM FOR AMPULLA OF VATER CANCER WITH HIGHER DISTINCTION ABILITY; MULTINATIONAL STUDY FROM EASTERN AND WESTERN J. -Y. Jang1, M. J. Kang1, J. He2, S. Y. Lee3, T. Park4, S. -W. Kim1 and C. Wolfgang2 1 Department of Surgery, Seoul National University, Republic of Korea, 2Department of Surgery, Johns Hopkins School of Medicine, United States, 3Department of Mathematics and Statistics, Sejong University, College of Natural Science, and 4Department of Statistics, Seoul National University, College of Natural Sciences, Republic of Korea Introduction: Having little data to verify current staging system, AJCC staging system for ampulla of Vater (AoV)
e27
FP06-04 - Table
TYPE
A1
A2
B1
B2
Ex+RYHJ
C1
C2
D1
D2
TOTAL (%)
60
247
19
44
373 (82.7%)
38
38 (8.4%)
Ex+Hx+RYHJ Hx
24
11
LTx
3^
35 (7.8%)
3
3 (0.7%)
Post-OP Complications (Grade:n) PHLF
51 (11.3%) 2 (a:2)
Biliary leak
4 (a:4)
Pancreatic leak Intraperitoneal bleeding
2 (a:1, b:1)
1 (a:1)
3 (a:3)
5 (1.1%) 20 (4.4%)
9 (a:7, b:2)
2 (a:2)
5 (a:3, b:2)
5 (a)
1 (a)
2 (a:1, c:1)
8 (1.8%)
3#(a:2, c:1)
10 (2.2%)
4 (a:2, b:1, c:1)
[Treatment and outcomes of Each Type of CC]
The new classification system could serve as a common language for CC and standardize the surgical treatment which should be precisely tailored for each patient.
FP06-05 IS STAGING LAPAROSCOPY USEFUL IN THE MANAGEMENT OF HILAR AND INTRA-HEPATIC CHOLANGIOCARCINOMA? A U.K. TERTIARY REFERRAL CENTRE EXPERIENCE N. Bird1, M. Elmasry2, M. Kelly1, R. Jones2, A. Pieri3, T. Greenhalgh4, M. Elniel4, A. McKenna4, D. Ormesher4, S. Bird4, E. Wakeford4, A. Tufo4, S. Fenwick5, J. Evans2, G. Poston5, H. Malik5 and Liverpool Hepato-Biliary MRC GROUP 1 HPB Surgery, University Hospital Aintree, 2Liverpool University, 3Gateshead Queen Elizabeth Hospital, 4University Hospital Aintree, and 5Hepato-Biliary Surgery, University Hospital Aintree, United Kingdom Introduction: Staging laparoscopy is part of the routine management of cholangiocarcinoma for determining if there is occult intra-abdominal metastatic disease not discernible on cross-sectional imaging. The aim was to determine the utility of staging laparoscopy in a retrospective cohort of hilar and intra-hepatic cholangiocarcinoma patients at a large tertiary referral centre. Methods: A database of 110 cholangiocarcinoma patients undergoing staging laparoscopy over an 8 year period from June 2007 to June 2015 was retrospectively analysed. The efficacy of staging laparoscopy in terms of Yield, Positive-Predictive-Value, False-Discovery-Rate and Specificity of the test was then calculated. Patients Undergoing Laparoscopy
Patients Undergoing Laparotomy
Total Number of Patients
110
80
Male: Female
63:47
47:33
Disease Precludes Further Surgery
30
16
Peritoneal Mets
15
11
Intra-Hepatic Mets
2
6 (continued on next page)
HPB 2016, 18 (S1), e1ee384
(continued ) Patients Undergoing Laparoscopy
Patients Undergoing Laparotomy
Locally Advanced
6
8
Poor Liver Quality
4
0
Resection
0
64
[110 Laparoscoped Cholangiocarcinoma Patients]
Results: The Yield of laparoscopy precluding further surgery was 27.2% (30/110). The Positive-Predictive-Value of laparoscopy was 80% (64/80). The False-Discovery-Rate was 20% (1-PPV). The Specificity of laparoscopy was 65.2% (30/46). 42.3% of patients with peritoneal metastases proceeded to laparotomy. 47/64 (73.4%) resections had cholangiocarcinoma; 14/64 (21.3%) benign disease; 3/64 (4.7%) other tumours. Mean age 63.2 Conclusions: The high Positive-Predictive-Value of 80% indicates that staging laparoscopy is highly precise in confirming radiological resectable intra-hepatic and hilar cholangiocarcinoma. However, the relatively low Specificity 65.2% indicates that in borderline resectable cases laparoscopy’s utility is more limited.
FP06-06 PROPOSAL OF A NEW STAGING SYSTEM FOR AMPULLA OF VATER CANCER WITH HIGHER DISTINCTION ABILITY; MULTINATIONAL STUDY FROM EASTERN AND WESTERN J. -Y. Jang1, M. J. Kang1, J. He2, S. Y. Lee3, T. Park4, S. -W. Kim1 and C. Wolfgang2 1 Department of Surgery, Seoul National University, Republic of Korea, 2Department of Surgery, Johns Hopkins School of Medicine, United States, 3Department of Mathematics and Statistics, Sejong University, College of Natural Science, and 4Department of Statistics, Seoul National University, College of Natural Sciences, Republic of Korea Introduction: Having little data to verify current staging system, AJCC staging system for ampulla of Vater (AoV)