A Clinical Review for Peripheral Cholangiocarcinoma

Choi, Sang Seok; Nam, Chang Woo; Lee, Young Joo; Park, Kwang Min; Lee, Sung Gyu

Abstract

PURPOSE: A peripheral cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile ducts proximal to the second-order branch of the main hepatic duct, has a poor prognosis against various treatment modalities. We analyzed the clinical characteristics of peripheral cholangiocarcinomas and evaluated the outcomes of surgical treatment.
METHODS
A retrospective study of 46 peripheral cholangiocarcinoma cases for which surgical exploration was performed at the Asan Medical Center over a 7-year period was conducted.
RESULTS
Clinical manifestations on admission were abdominal pain including epigastric pain (89%), weight loss (33%), fever (28%), jaundice (24%), a palpable mass (20%), and general weakness (11%). Associated diseases were hepatolithiasis in 54.3% and clonorchiasis in 9%. Positive findings showing a hepatic mass were found in 75% of the cases by using computed tomography and in 52% of the cases by using ultrasonography. Angiographic hypervascularity was seen in 17.4% of the cases and hypovascularity in 82.6%. The gross morphologic types of the peripheral cholangiocarcinomas were mass-forming (74%), periductal infiltrative (17%), and intraductal growing (17%). Nodal metastasis was found in 48% of the patients. The location of the peripheral cholangiocarcinoma was the left lobe (54%), the right lobe (35%), the caudate lobe (4%) and both lobes (6%). Of the 46 patients, 29 underwent a hepatic resection from the lateral segmentectomy to the right trisegmentectomy, and 17 cases underwent palliative surgery. The 1-year and 2-year survival rates of the hepatic-resection cases were 62% and 50%, respectively. The 1-year and 2-year survival rates of the palliative-surgery cases were 32% and 21%, respectively univariate analysis showed that tumor size, growth pattern, nodal metastasis, the extent of the hepatic resection, and node dissection did not significantly affect the survival of the patients.
CONCLUSIONS
Careful preoperative evaluation using computed tomography, ultrasonography, and angiography and a study of tumor markers for the possibility of a peripheral cholangiocarcinoma is necessary in risk groups with hepatolithiasis or clonorchiasis. Hepatic resection should be used in hepatolithiasis patients to improve the chance of survival.