title: Surgical therapy for hiliar cholangiocarcinoma: analysis of 198 cases.
abstract: BACKGROUND
  Carcinoma of the hepatic duct confluence is the most common site of bile duct malignancies. Although hilar cholangiocarcinoma has been characterized as a slow-growing and late metastasizing tumor, post-therapeutic prognosis has remained poor. The study was undertaken to analyze factors influencing the surgical curative effect of hilar cholangiocarcinoma.
  
  
  METHODS
  A retrospective clinical analysis was made of 198 patients with hilar cholangiocarcinoma who had been surgically treated at our hospital from 1997 to 2002. Jaundice (94.5%, 187 patients), pruritus (56.6%, 112) and abdominal pain (33.8%, 67) were the main symptoms. According to the Bismuth-Corlette classification, there were 14 type I patients, 19 type II patients, 12 type IIIa patients, 15 type IIIb patients, 112 type IV patients, and 26 unclassified patients. 144 patients received laparotomy, and 120 tumor resection including radical resection (59 patients) and palliative resection (61). Fifty-four patients were treated by endoscopic surgery and 16 patients by postoperative adjuvant radiation.
  
  
  RESULTS
  Occupation, preoperative level of total serum bilirubin, operative procedure and postoperative adjuvant radiation affected postoperative survival of the patients. The postoperative survivals of endoscopic nose-biliary drainage (ENBD) group, endoscopic retrograde biliary drainage (ERBD) or endoscopic metal biliary endoprosthesis (EMBE) group, biliary exploration and drainage group, palliative resection group and radical resection group differed (chi2=87.0489, P<0.01).
  
  
  CONCLUSIONS
  Early diagnosis and radical resection are important to improve the prognosis of hilar cholangiocarcinoma.
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China. zhbh001@gmail.com
authors.forename: Bai-He
authors.initials: BH
authors.lastname: Zhang
authors.forename: Qing-Bao
authors.initials: QB
authors.lastname: Cheng
authors.forename: Xiang-Ji
authors.initials: XJ
authors.lastname: Luo
authors.forename: Yong-Jie
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Jiang
authors.forename: Bao-Hua
authors.initials: BH
authors.lastname: Zhang
authors.forename: Bin
authors.initials: B
authors.lastname: Yi
authors.forename: Wen-Long
authors.initials: WL
authors.lastname: Yu
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D001707:Biopsy, Needle; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome