Outcome of surgical resection for hilar cholangiocarcinoma

Abstract

Background: Hilar cholangiocarcinoma (HC) is an adenocarcinoma of the extrahepatic biliary tree arising from the main left or right hepatic ducts or their confluence. HC is still considered to be a disease which is difficult to treat or to cure. Its prognosis is very poor and the only curative treatment is complete resection with a negative surgical margin. Preoperative evaluation of the tumor is important in order to evaluate resectability and the extent of surgery. Surgical resection involves either local resection, local excision with caudate lobectomy or major hepatic resection with caudate lobectomy.The aim of this work was to study the feasibility and outcome of surgical resection for hilar cholangiocarcinoma. Methods: This study was carried out on 72 patients with radiological evidence suggesting resectable hilar cholangiocarcinoma presented to the Gastrointestinal Surgery Unit, Main Alexandria University Hospital during the period from March 2006 till January 2013. All patients'presentations, laboratory and radiological data, surgical procedures, complications, follow-up and survival data were collected Results: Between March 2006 and January 2013; 72 patients (56 males and 16 females) were admitted for resection of a radiologically suspected resectable hilar cholangiocarcinoma. All patients presented with obstructive jaundice of varying degrees. The tumors were Bismuth­ Corlette typelin36patients, typellin 24patients, type!Ilain 5patientsandtype!Ilbin 7patients. All patients underwent surgical resection. Forty-six patients underwent bile duct resection with hepaticoj([/unostomy and regionallymph node dissection. Fourteen patients underwent bile duct resection and lymph node dissection with caudate lobectomy. Three patients underwent right hepatectomy, two patients underwent extended right hepatectomy, four patients underwent left hepatectomy and three patients underwent extended left hepatectomy; all with hilar bile duct resection, caudate lobectomy and regional lymph node dissection. Complete resection (RO) was achieved in 65 patients {90.3%), while 7 patients (9.7%) had incomplete resection. All over 9 patients (12.5) developed recurrence. The 3 and 5-years overall survival rate for all patients, using the Kaplan-Meier actuarial curve, were 51.4% and 34.7% respectively. Conclusion: Cholangiocarcinoma remains a devastating disease. Most patients have unresectable tumors at the time of diagnosis and have a dismal prognosis. Complete resection is the only treatment that offers any hope of long-term survival but is possible in few patients. Furthermore, even after resection, disease recurrence is common. Acfjuvant therapy has not been shown to have a role in this disease.