322 Photodynamic Therapy Versus Incomplete Resection in Hilar Cholangiocarcinoma

Abstract

Introduction: The best therapeutic option for patients with Klatskin tumors is curative resection, achieving 5-year survival rates of 20-40%. Unfortunately potentially curative resection can only be obtained in 60% of patients. It is supposed, that even incomplete resection (R1-resection) shows a significant survival benefit. In palliative situations only photodynamic therapy (PDT) could demonstrate a significant prolongation of survival. The aim of this study was to compare survival and complication rates of R1-resection of hilar cholangiocarcinoma and PDT. Patients and Methods: Patients receiving incomplete resection or palliative PDT for hilar bile duct cancer were analyzed retrospectively for survival time and complications. Patients with nonresectable bile duct cancer receiving only endoscopic stenting served as controls. Results: 32 patients in the PDT group, 21 patients in the incomplete resection group and 15 patients receiving mere endoscopic stenting were compared retrospectively. The groups did not differ significantly in gender or tumor type according to the Bismuth classification. Patients receiving resection were significantly younger (median age 62y vs. 68y) than the PDT patients. Median survival time after incomplete resection was 451 days [95% CI: 177-725], as compared to 630 days [95 CI: 385-875] after PDT (p=0,33). In contrast, median survival after endoscopic stenting alone was significantly lower with 180 days [95% CI: 83-277] (p=0,012). Major complications occurred in 50% of patients after resection, necessitating relaparotomy in 24% of patients. 30-day mortality rate was 19%, with fatal liver failure in 9,5% of patients. After PDT 30-day mortality rate was 0% and no severe phototoxicity was observed. 25% of patients developed severe bacterial cholangitis. Conclusions: Palliative PDT shows comparable survival rates to incomplete resection with significantly lower procedure related morbidity and mortality. Adjuvant PDT after incomplete resection should be evaluated in randomized controlled studies.