Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):319-326. 10.14701/ahbps.2019.23.4.319.

Comparison of the clinical results of surgical resection for extrahepatic cholangiocarcinomas: Hilar cholangiocarcinoma and mid-to-distal cholangiocarcinoma

Affiliations
  • 1Department of Surgery, Korean Cancer Center Hospital, Seoul, Korea. gsceh@kirams.re.kr
  • 2Department of Surgery, Dongnam Institution of Radiological and Medical Science, Busan, Korea.

Abstract

BACKGROUNDS/AIMS
Hilar cholangiocarcinomas (HLC) are known to have worse prognoses than mid-to-distal cholangiocarcinomas (CBDC). We analyzed the clinical results of surgical resections for extrahepatic cholangiocarcinomas to validate the differences in the prognoses of HLC and CBDC.
METHODS
Two hundred and eighty-one patients underwent curative surgical resections for extrahepatic cholangiocarcinomas at the Department of Surgery in the Korea Cancer Center Hospital. Among them, we analyzed the T2 and T3 patients and compared the clinical results between those with HLC (n=74) and those with CBDC (n=65).
RESULTS
The rate of R1 resections was significantly higher in the HLC patients compared to the CBDC patients (31.1% vs 12.3%, p=0.006). The overall survival rate of the T2/T3 patients was lower in the HLC group than in the CBDC group (24.5% vs 51.7, p=0.039). The recurrence-free survival rate was 23.3% in the HCL patients and 50.9% in the CBDC patients (p=0.06). In the subgroup analysis, the survival rates were not different in patients who had lymph node metastases or in patients who underwent R1 resections between the HLC and CBDC patients. Poor independent prognostic factors for the overall and recurrence-free survival rates in the T2/T3 extrahepatic cholangiocarcinoma patients were the presence of lymph node metastases and the hilar locations of tumor.
CONCLUSIONS
HLC patients had poorer prognoses than CBDC patients. However, in patients with lymph node metastases, the prognosis was poor and was not different between the HLC and CBDC patients. Other adjuvant treatment methods are needed for extrahepatic cholangiocarcinoma patients with lymph node metastases to improve their prognoses.

Keyword

Hilar cholangiocarcinoma; Mid-to-distal cholangiocarcinoma; Prognosis

MeSH Terms

Cholangiocarcinoma*
Humans
Klatskin Tumor*
Korea
Lymph Nodes
Neoplasm Metastasis
Prognosis
Survival Rate

Figure

  • Fig. 1 Comparison of the overall-survival rates with hilar cholangiocarcinoma and distal bile duct cancer according to cancer location (T2/T3).

  • Fig. 2 Comparison of the overall-survival rates between hilar cholangiocarcinoma and distal bile duct cancer according to T stages.

  • Fig. 3 Comparison of the overall-survival rates between hilar cholangiocarcinoma and distal bile duct cancer according to N stages.

  • Fig. 4 Comparison of the overall-survival rates between hilar cholangiocarcinoma and distal bile duct cancer according to R0/R1 resections.

  • Fig. 5 Comparison of the recurrence-free survival rates between hilar cholangiocarcinoma and distal bile duct cancer according to cancer location (T2/T3).

  • Fig. 6 Comparison of recurrence-free survival rates between hilar cholangiocarcinoma and distal bile duct cancer according to T stages.

  • Fig. 7 Comparison of the recurrence-free survival rates between hilar cholangiocarcinoma and distal bile duct cancer according to N stages.

  • Fig. 8 Comparison of the recurrence-free survival rates between hilar cholangiocarcinoma and distal bile duct cancer according to R0/R1 resections.


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