Diagnosis And Surgical Treatment For Hilar Cholangiocarcinoma: A Report Of 59 Cases

Objective To explore the early diagnosis methods and the correlation between prognosis and surgical management in patients with hilar cholangiocarcinoma.Methods Retrospective study was used to analyze the clinical features, operation methods, complications , death rate, survival time, recurrence and metastases after surgery of 59 patiens from September 1989 to January 2003.Results Of the 59 patients, 26 underwent resection (radical resetion, 17; palliative resection, 9) and 33 were subjected to nonresectional internal or external drainage. In the radical resection group ,the 1,2,3-year survival rates were 92.30%, 46.15%, 15.38% and the 1,2,3-year recurrence /metastasis rates were 15.38%, 61.54% , 84.61% respectively. The 1-year survival rate and 1-year recurrence/metastasis rates were 20% and 80% in the palliative resection group. Whereas ,none of the patients in the nonresection group survived over 10 monthes .The 1-year survival rate of the radical resection group was significantly higher than that of the palliative resection group and of the nonresection group (the radical resection group VS the palliative resection group , P=0.044; the radical resection group VS the nonresection group , P=0.000). whereas ,the 1-year recurrence/metastasis rate of the radical resection group was less than that of the palliative resection group and of the nonresection group (the radical resection group VS the palliative resection group, P=0.022; the radical resection group VS thenonresection group, P=0.000)Conclusion 1. Early diagnosis of hilar cholangiocarcinoma mainly relies on images . BUS should be regarded as primary modality of choice because of its convenience and non-injury. Combined with CT ,MRCP, PTC, ERCP and biopsy during operation ,the patients could be clearly diagnosed . 2. Radical resection is crucial to enhance survival rate and reduce recurrence/metastasis rate in hilar cholangiocarcinoma. Nonresectional drainage could prolong survival time or improve the quality of life among the patients with advanced hilar cholangiocarcinoma.