Analysis Of The Relation Between Surgical Procedure And Prognosis Of Hilar Cholangiocarcinoma

Objective To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it. Methods A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 55.9. Jaundice(94.5%), pruritus (56.6% ) and-abdominal pain ( 33.8 % ) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type Ilia cases. 15 type IIIb cases. 112 type IV cases and 26 unclassifiable cases. 144 cases received open operative treatment, and the others only were treated with endoscopic approach(including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage(2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%. included radical resection 59 cases(41.0%). 23 cases underwent paunched biliary exploration and drainage, and 1 case experienced tumor biopsy. Results The COX's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, surgical procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival differed statistically between radical resection group and other surgical procedure groups, also between palliative resection group and ENBD group, and between ERBD or EMBE group and ENBD group. Conclusion Surgical procedure was an important prognosic factor of hilar cholangiocarcinoma, radical resection still was the primary measure to cure and long term survival. For patient with hilar cholangiocarcinoma which did not receive radical resection, no evidence showedthat the prognosis treated by ERBD or EMBE was worse than that by laparotomy.