Open Access
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(02): E162-E168
DOI: 10.1055/a-2005-3679
Original article

Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making

David M. de Jong
1   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands 
,
Sanne van de Vondervoort
1   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands 
,
Roy S. Dwarkasing
2   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Radiology and Nuclear Medicine, Rotterdam, Netherlands 
,
Michael Doukas
3   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Pathology, Rotterdam, Netherlands 
,
Rogier P. Voermans
4   Amsterdam University Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands 
5   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands 
6   Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands 
,
Robert C. Verdonk
7   St. Antonius Hospital, Department of Gastroenterology and Hepatology, Nieuwegein, Netherlands
,
Wojciech G. Polak
8   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands
,
Jeroen de Jonge
8   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands
,
Bas Groot Koerkamp
8   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands
,
Marco J. Bruno
1   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands 
,
Lydi M.J.W. van Driel
1   Erasmus MC Cancer Institute University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands 
› Author Affiliations
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Abstract

Background and study aims Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with extraregional metastatic LNs (MLNs). This study investigates the added value of preoperative endoscopic ultrasound (EUS) with or without tissue acquisition (TA) for the detection of MLNs in patients with resectable pCCA.

Patients and methods In this retrospective, multicenter cohort study, patients with potentially resectable pCCA who underwent EUS preoperatively between 2010–2020, were included. The clinical impact of EUS-TA was defined as the percentage of patients who did not undergo surgical resection due to MLNs found with EUS-TA. Findings of cross-sectional imaging were compared with EUS-TA findings and surgery.

Results EUS was performed on 141 patients, of whom 107 (76 %) had suspicious LNs on cross-sectional imaging. Surgical exploration was prevented in 20 patients (14 %) because EUS-TA detected MLNs, of which 17 (85 %) were extraregional. Finally, 74 patients (52 %) underwent surgical exploration followed by complete resection in 40 (28 %). MLNs were identified at definitive pathology in 24 (33 %) patients, of which 9 (38 %) were extraregional and 15 (63 %) regional.

Conclusions EUS-TA may be of value in patients with potentially resectable pCCA based on preoperative cross-sectional imaging, regardless of lymphadenopathy at cross-sectional imaging. A prospective study in which a comprehensive EUS investigation with LN assessment and EUS-TA of LNs is performed routinely should confirm this promise.



Publication History

Received: 26 July 2022

Accepted after revision: 03 November 2022

Accepted Manuscript online:
30 December 2022

Article published online:
02 February 2023

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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