Surgical treatment and prognostic analysis of hilar cholangiocarcinoma: a report of 41 cases / 中华肝胆外科杂志

ABSTRACT

Objective To explore surgical strategy for patients with hilar cholangiocarcinoma (HCC) and study prognostic factors after curative treatment. Methods We retrospectively reviewed medical records of 41 patients with HCC surgically treated in our department during the 9-year period from January 1999 to February 2007. Clinicopathological factors were evaluated for their association with post-operational survival by univariate and multivariate analysis using Cox proportional hazard model. Results All the 41 patients underwent laparotomy following preoperative assessment of extent of disease and 21 patients (resectability rate 51.2%) ultimately underwent resection with curative in-tent. In the resection group, R0 radical resection was possible in 11 patients, while R1 resection in 6and R2 in 4. Different types of hepatectomy were combined to accomplish resection. Meanwhile, por-tal vein wedge resection or reconstruction was needed in two patients. The 1-, 3-and 5-year survival rates were 41.5%, 14.6% and 4.9% in the overall group and 71.3%, 28.6%, 9.5% in the resection group, respectively. In R0-resection, Rl-resection and R2 resection group, the 1-,3-and 5-year sur-vival rates were 81.8% ,45.5% ,18.2% ;66.7% ,16.7% ,0 and 50% ,0,0, respectively. Survival rates after resection were significantly higher than those after palliative drainage and exploratory laparotomy (P<0. 001). Higher survival rates were seen in R0-resected patients when compared with Rl-or R2-resected patients (P<0.001). Multivariate analysis revealed that tumor-free margins, pTNM stage and combined hepatectomy were independent prognostic factors affecting survival. Conclusion Only surgery can provide chance to achieve the possibility of cure and long-term survival. Tumor-free margins, pTNM stage and combined hepatectomy are the most important prognostic factors affecting the survival.