Epidemiology of hilar cholangiocarcinoma in Egypt: single center study.

BACKGROUND/AIMS: Cholangiocarcinoma is the second most frequent malignant tumor of the liver after hepatocellular carcinoma. The incidence rates of hilar cholangiocarcinoma (CC) vary greatly among different areas of the world, this variation is related to distribution of risk factors. The aim of this work is to study epidemiology and possible risk factors in the North East delta of Egypt. METHODOLOGY: This study included 440 patients with hilar cholangiocarcinoma who were admitted to the Gastrointestinal Surgical Center, Mansoura University between January 1995 and October 2004. After complete evaluation by thorough history, clinical examination, biochemical assessment including liver function tests, kidney function tests, blood picture and serology of viral markers, tumor markers and radiological investigation. RESULTS: The mean age was 54.49 +/- 12.8 (range 23 to 82 year). Male to female ratio was 1.7:1, with increasing annual incidence from 22 patients at 1995 up to 68 patients in 2003 and 60 patients in the first 10 months of 2004. Hilar CC is common in patients coming from rural areas especially in Dakahlia government area (41%). All patients presented with jaundice, while weight loss was presented in 41%, and right upper abdominal pain in 37% of patients. Positive history of schistosomiasis infection was encountered in 66.5% while typhoid infection was in 52% of patients with high prevalence of both in rural versus urban (89% vs. 13%, p < 0.001 & 66% vs. 25%, p < 0.001). Laboratory assessment revealed 238 (54%) patients HCV positive while HBs antigen positive in 10 (2%) with high significant increase of HCV in rural versus urban (70% vs. 16%, p < 0.001). Gallstones was significantly higher in rural versus urban (28% vs. 40%, p = 0.016). The laboratory data showed highly significant increase in serum alkaline phosphatase, CA19.9 (26.9 +/- 1 4.4mg/dL, 56.3 +/- 30.6 KAU, 517.8 +/- 279.2 u/mL respectively). CONCLUSIONS: We conclude that, the number of newly diagnosed cases increases annually, it is common in males especially in farmers and rural residents. Liver cirrhosis, HCV, bilharziasis, chronic typhoid infection and gallstones can be possible risk factors for hilar cholangiocarcinoma in Egypt.

Resectability and prognostic factors after resection of hilar cholangiocarcinoma.

BACKGROUND/AIMS: Hilar cholangiocarcinoma, still a challenging problem for surgeons and resectional surgery, is the treatment of choice for long-term survival. In this study we tried to evaluate different prognostic factors after resection. METHODOLOGY: From January 1995 to October 2004, 440 patients with hilar cholangiocarcinoma were admitted to the Gastroenterology Surgical Center, Mansoura University, Egypt. Of these patients 73 underwent potentially curative resection giving respectability rate of 17%, and the remaining 367 patients underwent non-surgical treatment because of advanced disease, advanced cirrhosis and poor general condition. Of the 73 patients, 35 (48%) underwent localized hepatic resection and 38 (52%) patients underwent major hepatic resection. Various prognostic factors for survival were evaluated by univariate and multivariate analysis. RESULTS: Hospital mortality occurred in 8 (11%) patients. The most common postoperative complications were: bile leak, liver cell failure and wound infection 23.2%, 17.8% and 9.5% respectively. The survival rates at 1, 2, 3, 4, and 5 years were 79%, 32.6, 18.5, 137% and 13% respectively. The result of univariate analysis revealed that radicality of resection, lymph nodes status, tumor differentiation, modified Bismuth staging, underlying liver pathology, HCV viral infection, blood transfusion, preoperative serum bilirubin <10mg and CA19-9 are dependent prognostic factors. By multivariate Cox analysis radicality of resection, lymph nodes status, serum bilirubin below 10mg/dL level of CA19-9 and hepatitis viral infection were independent predictor factors. CONCLUSIONS: From this study we found that aggressive surgical procedure to obtain curative resection with preoperative serum bilirubin below 10mg and HCV infective negative especially in noncirrhotic liver may bring a better prognosis in hilar cholangiocarcinoma.

Hepatic resection in cirrhotic liver for treatment of hepatocellular carcinoma in Egyptian patients. Experience with 140 cases in a single center.

BACKGROUND/AIMS: In many centers hepatic resection is still the treatment of choice for hepatocellular carcinoma in cirrhotic liver. Several factors affect the prognosis; one of them is the extent of resection. This study retrospectively evaluates outcome after different types of hepatic resection in cirrhotic liver. METHODOLOGY: Hepatectomy was performed in 245 patients. From them, 140 patients were subjected to hepatic resection for hepatocellular carcinoma in cirrhotic liver. According to the type of resection the patients were divided into three groups (A, B and C), major resection (group A) in 79 (56.3%), segmental resection (group B) 31 (22.1%) and localized resection (group C) in 30 (21.4%). Early postoperative mortality and morbidity as well as long-term survival and recurrence were assessed. RESULTS: The overall hospital mortality rate was (8.6%) with total complications 26%, recurrence rate 32.8% and median survival was 24 months (3-120). Group A showed high incidence rate of hospital mortality, total complications and hepatic cell failure than the other two types (p>0.05). On the other hand, group C patients showed high incidence of wound infection and recurrence rate after hepatic resection than the other two types (p>0.05). At the end of the study, the median survival was 18 months (4-120), 24 months (3-48) and 24 months (3-120) for the three groups respectively without significant difference. The overall 5-year survival rate was 20%, 0% and 15.3% for the three groups respectively (p>0.05). CONCLUSIONS: Although major liver resection in cirrhotic liver has high incidence of early mortality and morbidity, it gives low incidence of recurrence and better survival in comparison with segmental and localized resection. However it has to be reserved for large tumor in good liver and early cirrhosis.