J Korean Surg Soc.
2007 Aug;73(2):156-164.
Analysis of the Clinical Outcome and Prognostic Factors of Patients with Hilar Cholangiocarcinoma
- Affiliations
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- 1Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea. kimdg@catholic.ac.kr
Abstract
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PURPOSE: The aim of the present study was to find the proper treatment for improving the survival of patients with hilar cholangiocarcinoma by analyzing many factors affecting the patients' survival.
METHODS
Between January 1991 and April 2006, 152 patients with hilar cholangiocarcinoma and who underwent surgery were reviewed. One hundred fifteen patients underwent attempted curative resections, and 37 patients had findings that precluded any further intervention. Of the 115 patients who underwent curative resection, 38 patients underwent resection of the extrahepatic bile duct only and 77 patients underwent concomitant hepatectomy. The clinicopathogical data of these patients was analyzed.
RESULTS
The 3 year overall survival and disease-free survival rates were 41.2% and 52.5%, respectively. The overall recurrence rate was 40.9% (47/115) and of patients with recurrence, those who had been treated aggressively survived longer than those who had been treated conservatively (P=.039). Of the patients' factors that affected survival, only preoperative weight loss was meaningful (P=.024). Of the histologic factors, tumor cell differentiation (P=.048) and the presence of lymph node metastasis (P=.028) were associated with survival. Of the perioperative factors, only achievement of complete tumor resection affected survival. On comparing between resection of the extrahepatic bile duct only and concomitant partial hepatectomy, the latter achieved more definitely negative histologic margins (63.6% vs 39.5%, respectively, P=.037) at the expense of a more prolonged operation time and hospital stay and greater complications.
CONCLUSION
Preoperative weight loss, poor differentiation, lymph node metastasis and a positive histologic margin could be included in the poor prognostic factors affecting survival. Concomitant liver resection could be rationalized in that it could attain a more negative histologic margin for treating resectable hilar cholangiocarcinoma, but it could increase mortality and morbidity rates.
