Clinic Study And Follow-up On The Surgical Treatment Of Hilar Cholangiocarcinoma

The resection rate of hilar Cholangiocarcinoma has been prominently increased in recent years due to development of image diagnostic technology, perioperative management and surgical skills, which has led to improve of survival. Extended resection has been suggested by more and more surgeons in order to obtain a higher curative resection rate. But whether it is need to do extended surgery still remains controversial, because it maybe have a higher morbidity and mortality after extended surgery. The purpose of this study is to summarize the experiences in the diagnosis and treatment of hilar Cholangiocarcinoma in order to improve its prognosis.MATERIALS & METHODS The clinical records of 49 cases of hilar cholangiocarcinoma underwent surgical treatment between 1996-2002 were retrospectively reviewed. It included their clinical manifestations, laboratory examinations, operative procedures, pathological diagnoses, preoperative complications, postoperative morbidities and long-term results. All the cases were divided into three groups: Curative Resection(RO) Group, Palliative Resection(Rl) Group and Palliative Drainage(R2) Group. Survival analysis was performed by Kaplan-Meier method and the relationship between each of the clinicopathological variables and survival was assessed by Log-Rank test. The potential prognostic factors influencing survivals were identified by multivariate analysis. Statistical analysis was carried out on SPSS of version 10.0.RESULTSType B ultrasonography detected 65%(24/37) of hilar lesions but missed five out of seven cases who hadsimultaneous biliary stones. CT scan revealed 50% (14/28) of hilar tumors, but missed six out of seven cases who had simultaneous biliary stones. ERCP and MRCP revealed 100% of hilar cholangiocarcinomas.The resection rate and curative resection(RO) rate was 73.5%(36/49) and 38.8%(19/49), respectively. Perioperative morbidity was 38.8%(19/49), and mortality was 4.1%(2/49). The rate of follow-up was 91.8%(45/49). The mean survival time following curative resection(RO), palliative resection(Rl) and palliative drainage(R2) were 20.3, 24.5 and 7.7 months, respectively. There was no statistical significant difference in the survivals between the Curative Resection(RO) Group and Palliative Resection(Rl) Group. But both the Curative Resection(RO) group and Palliative Resection(Rl) Group had a better survival than palliative drainage(R2).Univariate analysis identified the following factors associated with better survival: resection of the primary tumor, age more than 60 years and early TNM stage. Multivariate analysis identified that only the age and TNMstage were significant independent prognostic factors. But resection of the primary tumor, sex, Bismuth type, negative margin, pathologic type, abdominal pain and preoperative levels of total bilirubin and serum albumin had no significant independent impact on prognosis.CONCLUSIONType B ultrasonography and CT scan can effectively detect hilar lesion. Coexistence of biliary stone was one of the main reasons for type B ultrasonography and CT scan to miss the diagnosis of hilar cholangiocarcinoma. MRCP was an ideal noninvasive examination for diagnosing hilar cholangiocarcinoma. MRCP could delineate hilar lesion accurately as well as ERCR Both curative resection(RO) and palliative resection(Rl) had advantage in survival over palliative resection(R2). Age more than 60 years and early TNM stages were associated with better survival.