title: Radical resection of hilar bile duct carcinoma and predictors of survival.
abstract: BACKGROUND
  Patients with carcinoma of the main hepatic duct have a poor prognosis. This study attempted to identify clinicopathological predictors of survival after resection.
  
  
  METHODS
  A retrospective review was performed of 114 patients who presented with hepatic ductal carcinoma between 1976 and 1998. Of the 114 patients, 98 had a radical resection, three underwent palliative resection and 13 were not treated surgically. Forty-six patients with stage IVA disease had microscopic tumour residue after resection. Of these, 28 patients were treated with radiotherapy and the remaining 18 had resection alone.
  
  
  RESULTS
  The overall operative morbidity and mortality rates were 14 and 4 per cent respectively. The overall 5-year survival rate after resection was 28 per cent. Nineteen patients survived for more than 5 years, including ten with stage IVA disease. The main prognostic factors were performance status; jaundice; tumour location; gross appearance; histological grade; T, N and M categories in tumour node metastasis (TNM) classification; TNM stage; and residual tumour. Adjuvant radiotherapy, tumour extension into the hepatic ducts, histological grade, N and residual tumour were independent predictive factors by multivariate Cox analysis.
  
  
  CONCLUSIONS
  This study suggests that radical resection provides the best survival rate for patients with hilar bile duct carcinoma. For patients with stage IVA disease, following complete gross resection radiotherapy improved treatment outcome.
authors.affiliation: Department of Surgery, Institute of Clinical Medicine and Department of Epidemiology and Biostatistics, Institute of Community of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Todoroki
authors.forename: T
authors.initials: T
authors.lastname: Kawamoto
authors.forename: N
authors.initials: N
authors.lastname: Koike
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
authors.forename: S
authors.initials: S
authors.lastname: Yoshida
authors.forename: H
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Y
authors.initials: Y
authors.lastname: Takada
authors.forename: M
authors.initials: M
authors.lastname: Otsuka
authors.forename: K
authors.initials: K
authors.lastname: Fukao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006500:Hepatic Duct, Common; D006801:Humans; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome