Spectrum of Cholangiocarcinoma with Special Emphasis on Treatment Modalities and Outcome at a Rural Tertiary Care Centre.

ABSTRACT

Cholangiocarcinoma (CCA) is a heterogeneous group of aggressive malignancies emerging from the canals of Hering to the CBD. CCA are rare tumours accounting for 3% of gastrointestinal tumours with an incidence of <2/100000, with an increased incidence in Asia. They present late and have a grave prognosis. The only curative option is surgical resection. The aim was to study the demographic and clinical spectrum of CCA with special emphasis on practicable diagnostic modalities, treatment strategies and their outcome at our rural tertiary setup.METHODSThis was a single centre observational study with a longitudinal design conducted over a period of 2 years. 30 patients presenting with features or diagnosis of CCA to the Department of General Surgery and the Department of Radiotherapy of North Bengal Medical College and Hospital, were studied with special reference to treatment and outcome. Data was collected, compiled on Excel sheet and analysed using GraphPad QuickCalcs 2018 (San Diego, CA).RESULTSMean age of the patients was 52.36 years with a female male ratio 1.51. They presented mainly with jaundice (90%), clay coloured stool (83.3%), pruritus (66.6%), anaemia (56.6%), abdominal lump (43.3%) and pain abdomen (33.6%) reflecting a late presentation. Diagnosis and staging were done by blood parameters and available imaging studies in our setup (abdominal ultrasound, CECT and MRCP). The most common type was Distal CCA (60%) followed by Perihilar CCA (33.3%) and Intra-hepatic CCA (6.6%). Pancreaticoduodenectomy was done in 26.6% of patients and resection with hepaticojejunostomy in 10% of patients; surgical biliary bypass in 20% of patients, chemotherapy in 6.6% and PTBD followed by chemotherapy in 36.6%. After 1 year 72.7% of those who underwent curative surgery were having disease free life and 26.3% of those who underwent palliative treatment were having improved quality of life.