Surgical treatments and efficacy of hilar cholangiocarcinoma

Abstract

Objective To explore the surgical treatments and the efficacy of hilar cholangiocarcinoma. Methods Clinical data of 113 patients with hilar cholangiocarcinoma in District of Huangdao, the Affiliated Hospital of Medical College Qingdao University from June 1999 to June 2009 were studied retrospectively. The informed consents of all patients were obtained and the ethical committee approval had been received. There were 55 males and 58 females with age ranging from 37 to 70 years old and a median age of 61 years old. After admitted in hospital, the patients underwent a comprehensive medical examination and received routine tests of liver function, tumor markers and imaging examinations. The surgical treatments included radical resection, palliative resection, internal drainage and external drainage. The patients were followed up after operation. The operation, death and incidence of complications were observed. Survival analysis were conducted using Kaplan-Meier method and Log-rank test. Results There were 22 cases with hilar cholangiocarcinoma of Bismuth-Corlette typeⅠ, 13 cases type Ⅱ, 21 cases type Ⅲa, 18 cases type Ⅲb, 39 cases type Ⅳ. The surgical resection rate was 72.6% (82/113), including radical resection (n=53), palliative resection (n=29), internal drainage (n=19), external drainage (n=12). Three cases died after operation, including 2 cases died of liver failure, 1 case died of upper gastrointestinal bleeding. After operation, upper gastrointestinal bleeding were observed in 3 cases, hepatic encephalopathy in 5 cases, bile leakage in 18 cases, abdominal infection in 3 cases, pleural effusion in 11 cases, wound infection and dehiscence in 7 cases. The 1-, 3-, 5-year cumulative survival rate were 76%, 39%, 11% respectively for patients of radical resection, 74%, 21%, 4% for palliative resection, 35%, 2%, 0 for internal drainage, and 28%, 0, 0 for external drainage. There were significant differences in the survival rates for patients of 4 surgical treatments (χ2=21.367, P<0.05). Conclusion Improvement of preoperative evaluation and selection of appropriate surgical approach help to improve the outcome and survival rate of patients with hilar cholangiocarcinoma. Key words: Bile duct neoplasms; Surgical procedures, operative; Drainage