title: The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients.
abstract: BACKGROUND
  Complete resection of hilar cholangiocarcinoma (HCCA) is a critical determinant of long-term survival. This study validates a previously reported preoperative clinical T staging system for determining resectability of HCCA.
  
  
  METHODS
  Consecutive patients with confirmed HCCA treated over an 18-year period were included. Patient demographics, preoperative imaging studies, resection type, margin status, lymph node status, histopathologic findings, morbidity, and outcomes were entered prospectively and analyzed retrospectively; changes in these variables over time were assessed. All patients were placed into 1 of 3 stages based on the extent of ductal involvement by tumor, portal vein compromise, or lobar atrophy.
  
  
  RESULTS
  From March 1991 through December 2008, 380 patients were evaluated. Eighty-five patients had unresectable disease; 295 patients underwent exploration with curative intent. One hundred fifty-seven patients underwent resection: 129 (82.2%) had a concomitant hepatic resection and 120 (76.4%) had an R0 resection. Of the 32 actual 5-year survivors (120 at risk), 30 patients (93.8%) had a concomitant hepatic resection. In patients who underwent an R0 resection, concomitant partial hepatectomy, well-differentiated histology, and negative lymph nodes were independent predictors of long-term survival. In the 376 patients whose disease could be staged, the preoperative clinical T staging system predicted resectability (p < 0.001), metastatic disease (p < 0.001), and R0 resection (p = 0.007).
  
  
  CONCLUSIONS
  The preoperative clinical T staging system of Blumgart, defined by the radial and longitudinal tumor extent, accurately predicts resectability of HCCA. The full outcomes benefit of resection is realized only if a concomitant partial hepatectomy is performed.
authors: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors: Kenichi
authors: K
authors: Matsuo
authors: Flavio G
authors: FG
authors: Rocha
authors: Kaori
authors: K
authors: Ito
authors: Michael I
authors: MI
authors: D'Angelica
authors: Peter J
authors: PJ
authors: Allen
authors: Yuman
authors: Y
authors: Fong
authors: Ronald P
authors: RP
authors: Dematteo
authors: Mithat
authors: M
authors: Gonen
authors: Itaru
authors: I
authors: Endo
authors: William R
authors: WR
authors: Jarnagin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology* / Q000601:surgery; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome