Evaluating the Clinical Applicability of the European Staging System for Perihilar Cholangiocarcinoma

Background: In 2011, a new European Staging System (ESS) for perihilar cholangiocarcinoma (PHC) was proposed with the expressed purpose of comparing treatment and outcomes data between institutions. The goal of this study was to evaluate the feasibility of ESS data capture. Study Design: Forty-seven consecutive patients who underwent surgical resection for PHC between 1999 and 2013 were studied. Demographic variables, components of various staging systems (including the ESS), preoperative and perioperative details, pathology, and outcomes were recorded. Results: The mean patient age was 63.2 and 62 % were male. Preoperative imaging included high-resolution CT in all patients, MRI in 34 %, and PET in 11 %. R0 resection was accomplished in 80 % of patients. Four patients (8.5 %) and 18 patients (38.3 %), respectively, received neoadjuvant or adjuvant therapy. During a mean follow-up of 36 months, recurrence rate was 51.3 % and 2- and 5-year survival rates were 69.4 and 33.3 %, respectively. Analysis of data capture found that tumor (T) classification was indeterminable in 7/47 patients (14.9 %). For two patients, the form (F) designation had insufficient data. The extent of vascular involvement (PV/HA) was different compared to preoperative imaging in nine patients (19.1 %). The liver remnant volume (V) was calculated in only 18 patients (38.3 %). The liver disease (D) variable did not account for four patients with inflammation/cirrhosis. In total, only 15 patients (31.9 %) had all required elements to complete the ESS. Conclusions: Without templated radiology, surgery, and pathology reports, the ESS cannot be applied to current clinical/research practice. Although resection continues to provide significant survival benefit to patients with perihilar cholangiocarcinoma, lack of an accurate prognostic tool for resectability and outcomes continues to be a major impediment to progress in the field.