title: Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach.
abstract: BACKGROUND
  Staging systems have been developed to predict survival after resection of hilar cholangiocarcinoma. Notably, they have not been validated nor compared for relative predictive ability.
  
  
  METHODS
  Forty-two patients underwent resection of hilar cholangiocarcinoma and have been followed through a prospectively collected database. The tumors were staged using the Bismuth-Corlette, Blumgart, and American Joint Committee on Cancer (AJCC) systems, and a significant relationship with survival was sought.
  
  
  RESULTS
  Eleven patients were treated by extrahepatic biliary resection alone, while 31 required extrahepatic biliary resections with in-continuity hepatic resections. All patients underwent adjuvant therapy. To date, 30 patients have died with a mean survival time of 30 months +/- 35.0 (SD). Twelve patients are alive with a mean survival of 90 months +/- 61.8. By regression analysis, none of the staging systems had a significant relationship with survival (Bismuth: P = .64; Blumgart: P = .66; AJCC: P = .31).
  
  
  CONCLUSIONS
  Most patients with hilar cholangiocarcinoma require in-continuity hepatic resections. Survival after resection promotes an aggressive approach, with cure in as many as 30%. Staging systems should not impact the decision to operate or postoperative management, as all tumors should be aggressively resected and all patients should receive adjuvant treatment.
authors.affiliation: Department of Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.forename: Dana
authors.initials: D
authors.lastname: Osborne
authors.forename: Steven B
authors.initials: SB
authors.lastname: Goldin
authors.forename: Desiree V
authors.initials: DV
authors.lastname: Villadolid
authors.forename: Donald P
authors.initials: DP
authors.lastname: Thometz
authors.forename: Alan
authors.initials: A
authors.lastname: Durkin
authors.forename: Larry C
authors.initials: LC
authors.lastname: Carey
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome