title: Intrahepatic, peri-hilar and distal cholangiocarcinoma: Three different locations of the same tumor or three different tumors?
abstract: BACKGROUND
  Few papers deal with pathologic characteristics and outcome of the 3 different cholangiocarcinomas based on location (intrahepatic, peri-hilar, distal). There is little evidence regarding similarity and differences.
  
  
  METHODS
  From two tertiary referral Italian Centers (in Bologna and Verona), 479 patients with cholangiocarcinoma were evaluated between 1980 and 2011. Several pathologic characteristics and their impact on survival were analyzed among resected patients for cholangiocarcinomas depending on the site of origin.
  
  
  RESULTS
  Tumour location was intrahepatic in 172 cases (36%), peri-hilar in 243 (51) and distal in 64(13%). Curative resection was performed in 339 (70%) patients. Intrahepatic cholangiocarcinoma showed higher probability to achieve R0 resection (81%), but was more frequently associated with presence of microvascular invasion (71%). Distal cholangiocarcinoma presented less R0 resections (58%), higher lymphnode involvement (60%) and lower microvascular invasion (49%). Hilar cholangiocarcinoma had intermediate characteristics (R0: 65% of cases). Median follow up was 30.2 ± 38 months; the 5 years overall survival was 31% in the resected population. Overall survival curves were similar among the three groups. At univariate analysis surgical margins, lymphnode status, perineural invasion, T category, TNM stage, microvascular invasion, tumour grading had significant impact on survival. At multivariate analysis, only microvascular invasion was significantly related to long term results (HR = 1,7; 95% CI = 1,0-2,5)".
  
  
  CONCLUSIONS
  Micro-vascular invasion has the strongest impact on survival in all three types of cholangiocarcinoma. In case of comparable pathologic characteristics and stage, the three tumors show similar outcome; depending on location, it shows a different tendency to invade bordering structures which affect the outcome.
authors.affiliation: General Surgery and Transplant Unit, Department of Medicine and Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: giorgio.ercolani@aosp.bo.it.
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: General Surgery and Transplant Unit, Department of Medicine and Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Dazzi
authors.affiliation: General Surgery and Pancreatic Surgery Unit, Department of Surgery, GB Rossi Hospital, University of Verona, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giovinazzo
authors.affiliation: Division of Surgery A, Department of Surgery, GB Rossi Hospital, University of Verona, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ruzzenente
authors.affiliation: General Surgery and Pancreatic Surgery Unit, Department of Surgery, GB Rossi Hospital, University of Verona, Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bassi
authors.affiliation: Division of Surgery A, Department of Surgery, GB Rossi Hospital, University of Verona, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Guglielmi
authors.affiliation: Department of Pathology, GB Rossi Hospital, University of Verona, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Scarpa
authors.affiliation: Department of Haematology and Oncologic Sciences, Sant'Orsola-Malpighi Hospital, Univeristy of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: D'Errico
authors.affiliation: General Surgery and Transplant Unit, Department of Medicine and Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000145:classification / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cholangiocarcinoma; Hepatectomy; Outcome; Prognosis; Risk factors