Occurrence of seeding metastases in resectable perihilar cholangiocarcinoma and the role of low-dose radiotherapy to prevent this

Table 1 Characteristics of patients undergoing resection for perihilar cholangiocarcinoma

Characteristics	Patients with PHC (n = 171)
Age, mean ± SD	64 (10)
Male, n (%)	104 (61)
ASA, n (%)
1	30 (18)
2	112 (65)
3	27 (16)
Missing	2 (1)
Drainage, n (%)
None	26 (15)
Endoscopic biliary drainage	81 (48)
Percunatenous biliary drainage	14 (8)
Both	50 (29)
Bismuth-Corlette type, n (%)
I	4 (2)
II	12 (7)
IIIa	85 (50)
IIIb	42 (25)
IV	24 (14)
Missing	4 (2)
Portal vein embolization, n (%)	20 (12)
Radiotherapy, n (%)	111 (65)
Resection type, n (%)
Left hemihepatectomy	61 (36)
Extended left hemihepatectomy	6 (4)
Right hemihepatectomy	40 (23)
Extended right hemihepatectomy	47 (27)
Minor liver resection	4 (2)
External bile duct resection only	13 (8)
+ Pancreatoduodenectomy	4 (2)
+ Portal vein reconstruction	43 (26)
90-d mortality, n (%)	22 (13)
90-d morbidity, n (%)	126 (74)
Severe morbidity (Clavien-Dindo ≥ 3), n (%)	96 (56)
Recurrence, n (%)	61 (36)
Local recurrence	37 (22)
Liver metastases	10 (6)
Lung metastases	2 (1)
Peritoneal metastases	7 (4)
Other	5 (3)

SD: Standard deviation; ASA: American society of anesthesiologists.

Table 2 Overview of studies reporting on incidence of seeding metastases in patients with perihilar cholangiocarcinoma

	Incidence	Patients
Sakata et al[8], 2005	3/67 (4.4%), cumulative 6%	Niigata University Graduate School of Medical and Dental Sciences; Percutaneous biliary drainage, 1998-2002
Kang et al[9], 2013	6/232 (2.6%) + 8 abdominal wall/wound implant metastases (3.4%)	Seoul National University Hospital; Percutaneous biliary drainage, 1991-2011
Kim et al[10], 2015	2/52 (3.8%)	Samsung Medical Center Seoul; Percutaneous biliary drainage, 2000-2012
Kawakami et al[5], 2011	3/48 (6.3%)	Hokkaido University Hospital; Percutaneous biliary drainage, 1999-2009
Hirano et al[16], 2014	3/67 (4.5%)	Hokkaido University hospital; Percutaneous biliary drainage, 2000-2008
Takahashi et al[7], 2010	19/339 (5.6%)	Nagoya University hospital, 1977-2007
Komaya et al[6], 2017	6/168 (3.6%)	Nagoya University Hospital Percutaneous biliary drainage, 2003-2012
Ten Hoopen et al[1], 1999	8/41 (20%)	AMC Amsterdam; Biliary drainage, 1983-1990
Wiggers et al[11], 2013	2/106 (1.9%)	AMC Amsterdam; Percutaenous + endoscopic biliary drainage, 1991-2012