Surgical procedure and prognosis of hilar cholangiocarcinoma

BACKGROUND: Hilar cholangiocarcinoma has a low radi-cal resection rate and a poor long-term survival rate. In re-cent years, its prognosis has been improved with advance-ment of preoperative diagnostic techniques and surgicaltechniques. The aim of this study was to evaluate the prog-nostic factors of hilar cholangiocarcinoma and the relationsof surgical procedure to the prognosis of the carcinoma.METHODS: A retrospective cohort study was done in 198patients with hilar cholangiocarcinoma (117 men and 81women, aged from 27 to 81 years) , who had been admit-ted to this hospital from December 1997 to December 2002.Their symptoms were jaundice (94.5%), pruritus (56.6%)and abdominal pain (33.8%). Bismuth-Corlette classifica-tion showed type in 14 patients, type in 19, type in12, type in 15, type in 112, and unclassifiable typein 26. 144 patients underwent laparotomy and others re-ceived bile drainage endoscopically (including endoscopicretrograde biliary drainage (ERBD) or endoscopic metalbiliary endoprosthesis (EMBE) in 21 patients, endoscopicnose-biliary drainage (ENBD) in 31 or percutaneous trans-hepatic cholangiodrainage in 2. 120 patients (83.3%) re-ceived tumor resection including radical resection in 59 pa-tients (41.0%). Twenty-three patients underwent paunchedbiliary exploration and drainage.RESULTS: Cox' s regression model analysis showed thatoccupation, preoperative total serum bilirubin level, opera-tive procedure and postoperative adjuvant radiation weresignificantly related to postoperative survival rate in con-trast to gender, age, choledocholithiasis, hepatitis, preope-rative serum CA19-9 level, Bismuth-Corlette type, his-topathologic grading and postoperative chemotherapy. Thesurvival of patients in groups of biliary drainage, palliativeresection and radical resection differed statistically and pro-longed in a descending order. No statistical difference wasfound between ERBD or EMBE group and palliative resec-tion group. So was between ERBD or EMBE group andbiliary drainage group, or between ENBD group and biliarydrainage group. The survival differed statistically betweenERBD or EMBE group and ENBD group.CONCLUSIONS: Operative procedure is the most impor-tant prognostic factor affecting the operative results of hilarcholangiocarcinoma. Radical resection is still the primarymeasure for a cure and long-term survival of the patients.For patients with irresectable hilar cholangiocarcinoma, noevidence has shown that the prognosis after treatment ofERBD or EMBE is poorer than that after laparotomy.