Outcome after resection of central cholangiocarcinoma: preliminary experience with 46 patients in a single center.
OBJECTIVE
Despite the enormous progress in surgery the management of cholangiocarcinoma remains a problem. In this study we present our preliminary experience in the surgical treatment of central cholangiocarcinoma.


METHODS
Between May 1997 and December 2001, 175 patients with central cholangiocarcinoma were admitted to our center. Of the 175 patients, 54 cases subjected to surgery, the remaining 131 patients did not undergo surgery because of advanced disease, advanced liver cirrhosis and poor general condition. Forty-six patients underwent surgical excision, their mean age was 53 +/- 3 years, and male to female ratio was 74-26%. All patients presented with jaundice associated with pain (30%) or biliary stones (32%). Surgical resection of the bile duct with or without part of segment IV were done in fourteen patients and bile duct resection together with major hepatectomy had been done in the remaining 28 patients.


RESULTS
Hospital mortality occurred in 10.8%; the main cause of mortality was hepatic cell failure. The most common complications were hepatic cell failure that occurred in 7 cases (15%), biliary leakage in 8 cases (17%), gastrointestinal bleeding in 3 cases (6.5%) and wound infection in 3 cases (6.5%). Late complication in the form of recurrence occurred in 12 cases (29.5%). cholangitis in 8 cases (19.5%), hepatic cell failure in 5 (12%) and gastrointestinal bleeding in 2 (4.8%). At the end of the study, 19 patients (46%) were alive with mean follow-up of 16.6 +/- 9 months. The survival rate at 6, 12, 18, 24 months was 92, 82, 52, 25, 18%, respectively. Recurrence and cholangitis were found significantly higher in the group without hepatectomy than the group after hepatectomy (p < 0.0001, p < 0.0016, respectively).


CONCLUSIONS
From our results we can conclude that major hepatectomy with excision of the extrahepatic bile duct system and caudate lobe resection may be recommended for the surgical treatment of central cholangiocarcinoma in selected cases.
Gastroenterology Center, Mansoura University, Mansoura, Egypt. Wahab_m_eg@yahoo.com
Mohamed Abdel
MA
Wahab
A
A
Sultan
N
N
Elgwalby
O
O
Fathy
M
M
Abo zied
A
A
Aboelenen
A
A
Fouad
T
T
Abd alla
T
T
Kandel
M
M
Elshobary
A
A
Elfiky
G
G
el Ebidy
N Gad
NG
Gad el Hak
F
F
Ezzat
D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002758:Cholangiography; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome