title: Resectability and prognostic factors after resection of hilar cholangiocarcinoma.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Gastroenterology Center, Mansoura University, Egypt. wahab_m_eg@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Abdel Wahab
authors.forename: O
authors.initials: O
authors.lastname: Fathy
authors.forename: N
authors.initials: N
authors.lastname: Elghwalby
authors.forename: A
authors.initials: A
authors.lastname: Sultan
authors.forename: E
authors.initials: E
authors.lastname: Elebidy
authors.forename: T
authors.initials: T
authors.lastname: Abdalla
authors.forename: M
authors.initials: M
authors.lastname: Elshobary
authors.forename: M
authors.initials: M
authors.lastname: Mostafa
authors.forename: A
authors.initials: A
authors.lastname: Foad
authors.forename: T
authors.initials: T
authors.lastname: Kandeel
authors.forename: A
authors.initials: A
authors.lastname: Abdel Raouf
authors.forename: T
authors.initials: T
authors.lastname: Salah
authors.forename: M
authors.initials: M
authors.lastname: Abu Zeid
authors.forename: A
authors.initials: A
authors.lastname: Abu Elenein
authors.forename: N
authors.initials: N
authors.lastname: Gad Elhak
authors.forename: A
authors.initials: A
authors.lastname: ElFiky
authors.forename: F
authors.initials: F
authors.lastname: Ezzat
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate