World Journal of Surgical Oncology (Oct 2024)

Improving postoperative survival in cholangiocarcinoma: development of surgical strategies with a screening program in the epidemic region

  • Vasin Thanasukarn,
  • Tharatip Srisuk,
  • Vor Luvira,
  • Theerawee Tipwaratorn,
  • Apiwat Jareanrat,
  • Krit Rattanarak,
  • Khanisara Kraphunpongsakul,
  • Natcha Khuntikeo,
  • Jarin Chindaprasirt,
  • Thanachai Sanlung,
  • Nittaya Chamadol,
  • Supinda Koonmee,
  • Prakasit Sa-Ngiamwibool,
  • Poramate Klanrit,
  • Arporn Wangwiwatsin,
  • Nisana Namwat,
  • Watcharin Loilome,
  • Nattha Muangritdech,
  • Piya Prajumwongs,
  • Nobuyuki Watanabe,
  • Tomoki Ebata,
  • Attapol Titapun

DOI
https://doi.org/10.1186/s12957-024-03573-5
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 11

Abstract

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Abstract Background The Cholangiocarcinoma Screening and Care Program (CASCAP) has been launched since 2013 to detect early-stage cholangiocarcinoma and reduce the disease death. However, the clinical utility of the CASCAP remains unclear. To compare survival outcomes between two time periods: before and after 2013, when significant changes in treatment strategies were implemented, and to evaluate the efficacy of the ultrasound-based screening program, in an Asian region endemic for cholangiocarcinoma. Methods A single-center retrospective review was conducted in curative-intended resection cholangiocarcinoma from 2002 to 2021. Patents characteristics and survival outcomes were compared between 2002 and 2013 (early period) and 2014 to 2021 (later period). Results A total of 1091 patients with intrahepatic (n = 624) or perihilar (n = 467) cholangiocarcinoma was included (early period, n = 658; later period, n = 433). Of 66 (15.2%) patients in the later period were referred by the CASCAP. The incidence of early-staged disease (Stage 0 and 1) was lower in early period compared to later period 16.0% versus 29.1% (p < 0.001); that of positive surgical margin was higher in early period 53.7% versus 40.0% (p < 0.001). A median survival time (MST) was 14 months in early and 40 months in later period (p < 0.001). Subgroup analysis by tumor location, the MST was 13 versus 60 months in early and late periods for intrahepatic tumor (p < 0.001), respectively. While MST in perihilar tumor was 18 versus 31 months in early and late periods(p < 0.001), respectively. By presentation, the MST was 51 vs. 38 months, respectively, with screening and usual presentation (p = 0.06). Conclusion Postoperative survival in CCA patients improved more than doubled during the study period. Moreover, the late period demonstrated enhanced early-stage detection, a higher rate of negative surgical margins, and improved survival outcomes.

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