Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2020; 12(11): 1089-1097
Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1089
Occurrence of seeding metastases in resectable perihilar cholangiocarcinoma and the role of low-dose radiotherapy to prevent this
Lotte C Franken, Eva Roos, Job Saris, Jeanin E van Hooft, Otto M van Delden, Joanne Verheij, Joris I Erdmann, Marc G Besselink, Olivier R Busch, Geertjan van Tienhoven, Thomas M van Gulik
Lotte C Franken, Eva Roos, Joris I Erdmann, Marc G Besselink, Olivier R Busch, Thomas M van Gulik, Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
Eva Roos, Joanne Verheij, Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
Job Saris, Jeanin E van Hooft, Department of Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
Otto M van Delden, Department of Interventional Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
Geertjan van Tienhoven, Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
Author contributions: Franken L, Saris J, van Gulik TM designed the research study; Franken LC, Saris J performed the research. van Hooft JE, Roos E, van Delden OM, Verheij J, Besselink MG, Erdmann JI, Busch OR, van Gulik TM contributed essential reagents or tools; van Tienhoven G contributed essential reagents or tools, interpretation of the data, revised work for important intellectual content; Franken L, Saris J analyzed the data; Roos E, van Gulik TM, van Delden OM, Erdmann JI, Busch OR, van Gulik TM interpretation of data; Franken L, van Gulik TM, Roos E and van Gulik TM wrote the paper; Van Hooft J, Roos E, van Delden OM, Verheij J, Besselink MG, Erdmann JI, Busch OR and van Gulik TM revised work for important intellectual content.
Institutional review board statement: The need for ethical approval was waived by the Medical Ethics Review Committee of the Amsterdam UMC, location AMC (W19_155).
Informed consent statement: The need for individual informed consent was waived by the Medical Ethics Review Committee of the Amsterdam UMC, location AMC (W19_155).
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lotte C Franken, MD, PhD, Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands. l.c.franken@amsterdamumc.nl
Received: April 13, 2020
Peer-review started: April 13, 2020
First decision: June 18, 2020
Revised: August 11, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: November 27, 2020
Processing time: 224 Days and 22.3 Hours
ARTICLE HIGHLIGHTS
Research background

Routine preoperative radiotherapy (3 times 3.5 Gray) to prevent the occurrence of seeding metastases was used in our tertiary center for 28 years in patients undergoing resection for perihilar cholangiocarcinoma.

Research motivation

Previous research from our department showed that seeding metastases occurred in up to 20% of the patients undergoing resection of perihilar cholangiocarcinoma.

Research objectives

To investigate the occurrence of seeding metastases among patients with resectable perihilar cholangiocarcinoma.

Research methods

A retrospective study was conducted, including all patients undergoing resection of perihilar cholangiocarcinoma in a larger tertiary center between 2000 and March 2019.

Research results

Seeding metastases occurred in 2 out of 171 patients (1.2%) undergoing resection for perihilar cholangiocarcinoma. These seeding metastases occurred at the laparotomy scar in both patients, after 17 and 21 mo, respectively. Intraoperative bile cytology showed no significant difference in the presence of tumor cells in the bile of patients undergoing preoperative radiotherapy or not.

Research conclusions

The incidence of seeding metastases in patients with resected perihilar cholangiocarcinoma has decreased. Evidence of a potential benefit of preoperative radiotherapy could not be delivered and therefore preoperative radiotherapy in patients with resectable perihilar cholangiocarcinoma has been discontinued in our institution.

Research perspectives

As we are the only center reporting on the use of low-dose radiotherapy to prevent seeding metastases in patients with perihilar cholangiocarcinoma, it is unlikely that other reports on this topic will appear and future research may focus more on the potential of stereotactic body radiation therapy to treat patients with unresectable perihilar cholangiocarcinoma.