Analysis of Survival Predictors After Surgical Resection of Hilar Cholangiocarcinoma (HCCC) In a Single Institute With Large Volume

Song, Gi Won; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Hwang, Shin; Kim, Ki Hun; Ahn, Chul Soo; Moon, Deok Bog; Ha, Tae Yong; Ryu, Je Ho; Park, Jeong Ikk; Lee, Hyo Jun

Abstract

PURPOSE: Although curative resection of hilar cholangiocarcinoma (HCCC) remains a difficult challenge, only curative resection with tumor free margins can guarantee a favorable outcome. In this report, we retrospectively analyzed the survival data after surgical resection of HCCC to determine the survival rate and the related factors at a single, large-volume medical institute.
METHODS
Between June 1989 and June 2005, surgical intervention with curative intent was performed on 301 patients. We retrospectively analyzed the survival data via a review of the medical record.
RESULTS
Among the 259 cases of resection, curative (R0) resection with tumor-free margins was achieved in 186 cases (71.8%). Of these 186 cases, 177 patients underwent various types of hepatectomy with caudate lobectomy and bile duct resection. Combined pancreatoduodenectomy was performed in 19 patients and portal vein resection was performed in 51 patients. In-hospital mortality developed in 11(4.3%) of the 259 patients who underwent resection. The 1-, 3- and 5-year survival rates of patients who underwent R0 resection were 83.3, 42.0 and 29.3%, respectively. Univariate analysis revealed that curability, T stage, lymph node involvement, histologic differentiation and perineural invasion were associated with patient survival. Multivariate analysis showed that curability and lymph node involvement were statistically significant prognostic factors.
CONCLUSION
Tumor-positive margins and lymph node involvement resulted in poor outcomes. Intensive perioperative management and a surgeon's aggressive efforts to attain clearance of tumor can minimize the postoperative mortality and maximize survival for patients with HCCC.