title: [Prognostic factors and long term outcome after surgery for hilar cholangiocarcinoma. Univariate and multivariate analysis].
abstract: Aim of the study was to evaluate the surgical strategy for the treatment of the hilar cholangiocarcinoma, focusing on the clinicopathological factors influencing the outcome. Between January 2001 and December 2003 23 patients out of 33 underwent surgery for hilar cholangiocarcinoma. All patients underwent resection of the extrahepatic biliary duct. This was the only treatment in patients with Bismuth-Corlette type I cholangiocarcinoma, or in patients not suitable for hepatic resection. In the other cases, resection of extrahepatic bile duct was associated to right or left hepatectomy. The univariate and multivariate analysis evaluated multiple clinicopathological factors in order to assess long term survival. Major hepatic resection was carried out in 19 (82%) patients. Hepatic resection extended to the segment 4 was performed in 5 patients. Also, left hepatectomy was carried out in 14 patients, while resection of the caudate lobe in 7 (30%) patients. No hospital mortality was recorded, while the overall morbidity was 43%. The 1 year survival rate was 63.2%, and the median survival rate 19 months. Recurrencies showed up in 12 patients (52%). Among the other factors, low level of albumin (p = 0.006), positive resection margins (p = 0.003) and T (p = 0.02) mostly affected the long term survival. Surgery is the gold standard for achieving curative treatment of hilar cholangiocarcinoma. The bile duct resection, along with hepatic resection, the best option to increase long term survival of these patients. The univariate and multivariate analysis showed that low albumin levels, positive resection margins and T are the most important factors influencing long term survival.
authors.affiliation: Università di Roma La Sapienza, II Facoltà di Medicina e Chirurgia, Ospedale Sant'Andrea, UOC di Chirurgia Epato-Bilio-Pancreatica.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: Nicola
authors.initials: N
authors.lastname: Cautero
authors.forename: Michele
authors.initials: M
authors.lastname: Masetti
authors.forename: Paolo
authors.initials: P
authors.lastname: Mercantini
authors.forename: Nicola
authors.initials: N
authors.lastname: Corigliano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Augusto
authors.initials: A
authors.lastname: Lauro
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Nicola
authors.initials: N
authors.lastname: De Ruvo
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome