Peri-hilar cholangiocarcinoma: results from the UK nationwide CAPBIL study

UK HPB Research Collaborative Group, United Kingdom

doi:10.1016/j.hpb.2025.08.003

Peri-hilar cholangiocarcinoma: results from the UK nationwide CAPBIL study

UK HPB Research Collaborative Group, United Kingdom

Belfast Health and Social Care Trust
Nottingham University Hospitals NHS Trust
Royal Surrey County Hospital NHS Foundation Trust
Royal Free London NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust
University Hospital Southampton NHS Foundation Trust
NHS Lothian, Edinburgh, UK.
Basingstoke and North Hampshire Hospital
University Hospital Coventry & Warwickshire NHS Trust
University Hospitals Bristol and Weston NHS Foundation Trust
Cambridge University Hospitals NHS Foundation Trust
Aintree University Hospital
King's College Hospital NHS Foundation Trust
East Lancashire Hospitals NHS Trust
Oxford University Hospitals NHS Foundation Trust
Cardiff and Vale University Health Board
Sheffield Teaching Hospitals NHS Foundation Trust
University Hospitals of Leicester NHS Trust
The Royal London Children's Hospital
The Royal Marsden NHS Foundation Trust, London, UK.
Leeds Teaching Hospitals NHS Trust
Newcastle upon Tyne Hospitals NHS Foundation Trust
University Hospitals Plymouth NHS Trust
University Hospitals of North Midlands NHS Trust

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: The role of liver transplantation as a treatment option for de novo resectable peri-hilar cholangiocarcinoma (pCCA) is controversial. This study investigated the outcomes following resection of early-stage pCCA in the UK.

METHODS: Patients undergoing resection for pCCA between 2014 and 2022 across 22 UK centres were included. Early-stage pCCA was defined as tumour size<3cm with no nodal disease (N0) on histopathology analysis. Clinical and survival data were collated.

RESULTS: Of the 450 patients included, 138 patients underwent resection for early-stage pCCA. In the early-stage pCCA group, CD ≥ IIIa morbidity was 39.1 % (n = 54) and 90-day mortality was 10.1 % (n = 14). Sixty-four (46.4 %) patients received adjuvant chemotherapy, but this was reduced in those with CD ≥ IIIa morbidity (n = 17, 31.5 %). Early-stage tumours had a significantly lower vascular invasion (n = 57, 41.3 %) and R1 margin (n = 46, 33.3 %) compared to later-stage pCCA [62.2 % (n = 194) and 54.2 % (n = 169) respectively, p < 0.001). The median disease-free and overall survival was significantly better in patients with early-stage pCCA compared to more advanced tumours (p < 0.001). Male gender (p = 0.039) and Post-Hepatectomy Liver Failure (PHLF, p = 0.010) were associated with significantly worse disease-free survival, while biliary drainage (p = 0.013), PHLF (p < 0.001) and vascular invasion (p = 0.030) were associated with significantly poorer overall survival.

CONCLUSION: Resection of early-stage pCCA tumours is associated with good clinical and survival outcomes in centralised HPB centres.

Original language	English
Pages (from-to)	1367-1378
Number of pages	12
Journal	HPB
Volume	27
Issue number	11
DOIs	https://doi.org/10.1016/j.hpb.2025.08.003
Publication status	Published - Nov 2025
Externally published	Yes

Keywords

Humans
Male
Female
Bile Duct Neoplasms/surgery
United Kingdom/epidemiology
Middle Aged
Aged
Hepatectomy/adverse effects
Treatment Outcome
Klatskin Tumor/surgery
Neoplasm Staging
Retrospective Studies
Time Factors
Risk Factors
Chemotherapy, Adjuvant
Adult
Cholangiocarcinoma/surgery
Liver Transplantation/mortality

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10.1016/j.hpb.2025.08.003

Cite this

@article{c51f73ca875a46eeac315ab3be05b260,

title = "Peri-hilar cholangiocarcinoma: results from the UK nationwide CAPBIL study",

abstract = "BACKGROUND: The role of liver transplantation as a treatment option for de novo resectable peri-hilar cholangiocarcinoma (pCCA) is controversial. This study investigated the outcomes following resection of early-stage pCCA in the UK.METHODS: Patients undergoing resection for pCCA between 2014 and 2022 across 22 UK centres were included. Early-stage pCCA was defined as tumour size<3cm with no nodal disease (N0) on histopathology analysis. Clinical and survival data were collated.RESULTS: Of the 450 patients included, 138 patients underwent resection for early-stage pCCA. In the early-stage pCCA group, CD ≥ IIIa morbidity was 39.1 \% (n = 54) and 90-day mortality was 10.1 \% (n = 14). Sixty-four (46.4 \%) patients received adjuvant chemotherapy, but this was reduced in those with CD ≥ IIIa morbidity (n = 17, 31.5 \%). Early-stage tumours had a significantly lower vascular invasion (n = 57, 41.3 \%) and R1 margin (n = 46, 33.3 \%) compared to later-stage pCCA [62.2 \% (n = 194) and 54.2 \% (n = 169) respectively, p < 0.001). The median disease-free and overall survival was significantly better in patients with early-stage pCCA compared to more advanced tumours (p < 0.001). Male gender (p = 0.039) and Post-Hepatectomy Liver Failure (PHLF, p = 0.010) were associated with significantly worse disease-free survival, while biliary drainage (p = 0.013), PHLF (p < 0.001) and vascular invasion (p = 0.030) were associated with significantly poorer overall survival.CONCLUSION: Resection of early-stage pCCA tumours is associated with good clinical and survival outcomes in centralised HPB centres.",

keywords = "Humans, Male, Female, Bile Duct Neoplasms/surgery, United Kingdom/epidemiology, Middle Aged, Aged, Hepatectomy/adverse effects, Treatment Outcome, Klatskin Tumor/surgery, Neoplasm Staging, Retrospective Studies, Time Factors, Risk Factors, Chemotherapy, Adjuvant, Adult, Cholangiocarcinoma/surgery, Liver Transplantation/mortality",

author = "\{UK HPB Research Collaborative Group, United Kingdom\} and Jane McClements and Amanda Koh and Harivinthan Sellappan and Lauren Blackburn and Adam Brooks and Jake Clements and Nabeel Merali and Adam Frampton and Syeda Gulbahar and Brian Davidson and Eyas Almomani and David Bartlett and Georgios Papadopoulos and Dimitrios Karavias and Alistair Rowcroft and James Lucocq and Harrison, \{Ewen M\} and Victoria Morrison-Jones and Fenella Welsh and Adithya Pathanki and Gabriele Marangoni and Paris Bruno and James Skipworth and Harry Spiers and Vasilis Kosmoliaptsis and Timothy Gilbert and Hassan Malik and Aarathi Vijayashanker and Krishna Menon and Waqqas Patel and Mohammed Bekheit and Lulu Tanno and Michael Silva and Christopher Brown and Nagappan Kumar and Joel Triance and Nehal Shah and Tareq Alsaoudi and Neil Bhardwaj and Hussein Nassar and Omar Mownah and Derek Yeung and Ricky Bhogal and Ruth Blanco-Colino and Shahid Farid and Rami Aljaberi and Sanjay Pandanaboyana and Omar Abdelmohsin and Somaiah Aroori and Daisy Evans",

year = "2025",

month = nov,

doi = "10.1016/j.hpb.2025.08.003",

language = "English",

volume = "27",

pages = "1367--1378",

journal = "HPB",

issn = "1365-182X",

publisher = "Elsevier B.V.",

number = "11",

}

TY - JOUR

T1 - Peri-hilar cholangiocarcinoma

T2 - results from the UK nationwide CAPBIL study

AU - UK HPB Research Collaborative Group, United Kingdom

AU - McClements, Jane

AU - Koh, Amanda

AU - Sellappan, Harivinthan

AU - Blackburn, Lauren

AU - Brooks, Adam

AU - Clements, Jake

AU - Merali, Nabeel

AU - Frampton, Adam

AU - Gulbahar, Syeda

AU - Davidson, Brian

AU - Almomani, Eyas

AU - Bartlett, David

AU - Papadopoulos, Georgios

AU - Karavias, Dimitrios

AU - Rowcroft, Alistair

AU - Lucocq, James

AU - Harrison, Ewen M

AU - Morrison-Jones, Victoria

AU - Welsh, Fenella

AU - Pathanki, Adithya

AU - Marangoni, Gabriele

AU - Bruno, Paris

AU - Skipworth, James

AU - Spiers, Harry

AU - Kosmoliaptsis, Vasilis

AU - Gilbert, Timothy

AU - Malik, Hassan

AU - Vijayashanker, Aarathi

AU - Menon, Krishna

AU - Patel, Waqqas

AU - Bekheit, Mohammed

AU - Tanno, Lulu

AU - Silva, Michael

AU - Brown, Christopher

AU - Kumar, Nagappan

AU - Triance, Joel

AU - Shah, Nehal

AU - Alsaoudi, Tareq

AU - Bhardwaj, Neil

AU - Nassar, Hussein

AU - Mownah, Omar

AU - Yeung, Derek

AU - Bhogal, Ricky

AU - Blanco-Colino, Ruth

AU - Farid, Shahid

AU - Aljaberi, Rami

AU - Pandanaboyana, Sanjay

AU - Abdelmohsin, Omar

AU - Aroori, Somaiah

AU - Evans, Daisy

PY - 2025/11

Y1 - 2025/11

N2 - BACKGROUND: The role of liver transplantation as a treatment option for de novo resectable peri-hilar cholangiocarcinoma (pCCA) is controversial. This study investigated the outcomes following resection of early-stage pCCA in the UK.METHODS: Patients undergoing resection for pCCA between 2014 and 2022 across 22 UK centres were included. Early-stage pCCA was defined as tumour size<3cm with no nodal disease (N0) on histopathology analysis. Clinical and survival data were collated.RESULTS: Of the 450 patients included, 138 patients underwent resection for early-stage pCCA. In the early-stage pCCA group, CD ≥ IIIa morbidity was 39.1 % (n = 54) and 90-day mortality was 10.1 % (n = 14). Sixty-four (46.4 %) patients received adjuvant chemotherapy, but this was reduced in those with CD ≥ IIIa morbidity (n = 17, 31.5 %). Early-stage tumours had a significantly lower vascular invasion (n = 57, 41.3 %) and R1 margin (n = 46, 33.3 %) compared to later-stage pCCA [62.2 % (n = 194) and 54.2 % (n = 169) respectively, p < 0.001). The median disease-free and overall survival was significantly better in patients with early-stage pCCA compared to more advanced tumours (p < 0.001). Male gender (p = 0.039) and Post-Hepatectomy Liver Failure (PHLF, p = 0.010) were associated with significantly worse disease-free survival, while biliary drainage (p = 0.013), PHLF (p < 0.001) and vascular invasion (p = 0.030) were associated with significantly poorer overall survival.CONCLUSION: Resection of early-stage pCCA tumours is associated with good clinical and survival outcomes in centralised HPB centres.

AB - BACKGROUND: The role of liver transplantation as a treatment option for de novo resectable peri-hilar cholangiocarcinoma (pCCA) is controversial. This study investigated the outcomes following resection of early-stage pCCA in the UK.METHODS: Patients undergoing resection for pCCA between 2014 and 2022 across 22 UK centres were included. Early-stage pCCA was defined as tumour size<3cm with no nodal disease (N0) on histopathology analysis. Clinical and survival data were collated.RESULTS: Of the 450 patients included, 138 patients underwent resection for early-stage pCCA. In the early-stage pCCA group, CD ≥ IIIa morbidity was 39.1 % (n = 54) and 90-day mortality was 10.1 % (n = 14). Sixty-four (46.4 %) patients received adjuvant chemotherapy, but this was reduced in those with CD ≥ IIIa morbidity (n = 17, 31.5 %). Early-stage tumours had a significantly lower vascular invasion (n = 57, 41.3 %) and R1 margin (n = 46, 33.3 %) compared to later-stage pCCA [62.2 % (n = 194) and 54.2 % (n = 169) respectively, p < 0.001). The median disease-free and overall survival was significantly better in patients with early-stage pCCA compared to more advanced tumours (p < 0.001). Male gender (p = 0.039) and Post-Hepatectomy Liver Failure (PHLF, p = 0.010) were associated with significantly worse disease-free survival, while biliary drainage (p = 0.013), PHLF (p < 0.001) and vascular invasion (p = 0.030) were associated with significantly poorer overall survival.CONCLUSION: Resection of early-stage pCCA tumours is associated with good clinical and survival outcomes in centralised HPB centres.

KW - Humans

KW - Male

KW - Female

KW - Bile Duct Neoplasms/surgery

KW - United Kingdom/epidemiology

KW - Middle Aged

KW - Aged

KW - Hepatectomy/adverse effects

KW - Treatment Outcome

KW - Klatskin Tumor/surgery

KW - Neoplasm Staging

KW - Retrospective Studies

KW - Time Factors

KW - Risk Factors

KW - Chemotherapy, Adjuvant

KW - Adult

KW - Cholangiocarcinoma/surgery

KW - Liver Transplantation/mortality

U2 - 10.1016/j.hpb.2025.08.003

DO - 10.1016/j.hpb.2025.08.003

M3 - Article

C2 - 40921691

SN - 1365-182X

VL - 27

SP - 1367

EP - 1378

JO - HPB

JF - HPB

IS - 11

ER -

Peri-hilar cholangiocarcinoma: results from the UK nationwide CAPBIL study

Abstract

Keywords

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