title: [Surgical treatment of 402 consecutive cases for hilar cholangiocarcinoma: Chinese single center experience].
abstract: OBJECTIVE
  To analyze clinical typing, pathologic characteristics of hilar cholangiocarcinoma (HCCA) and surgical strategies and their effects on HCCA, and to explore the factors that influence the surgical outcomes and long-term survival.
  
  
  METHODS
  The data of the 402 patients with HCCA admitted between January 1993 and December 2004 was investigated retrospectively. Primary outcomes examined included clinical typing, pathologic characteristics, surgical procedures and follow-up results. On the basis of Bismuth-Corlette typing, we defined the tumor originated from intrahepatic large bile duct (LBD) as type V (type Va and Vb).
  
  
  RESULTS
  Among the 402 patients with HCCA, 198 cases accepted curative resection, 102 (51.5%) for radical resection and 96 (48.5%) for palliative resection. Of the rest patients, 8 received orthotopic liver transplantation (OLT), 161 received simple drainage and 35 were not operated on. The resection rates for type I, II, IIIa, IIIb, IV, Va and Vb were 69.4%, 55.5%, 57.4%, 71.7%, 19.6%, 100% and 34.6%, respectively. The one-year survival rates for radical resection, palliative resection, simple drainage and untreated were 80.3%, 53.2%, 26.7% and 9.8%, respectively. And the three-year and five-year survival rates in the four groups were 41.9% and 33.3%, 19.6% and 14.7%, 3.3% and 0, 0 and 0, respectively. Significant difference was found in survival rates between the radical and palliative resection. In the patients who received tumor resection, the ones without lymph nodes metastasis (LNM) survived much longer than those with LNM (P < 0.05). Complications were found in 36.1% of the patients and the mortality rate was 0.3%.
  
  
  CONCLUSIONS
  HCCA type V originated from intrahepatic LBD has higher resection rate and better prognosis. The tumor differentiation is significantly correlated with the prognosis after operation. With HCCA, resection is still the major treatment selection. Curative resection carries the best effect. Extended radical resection of liver lobes, blood vessels, lymph nodes can prolong survive. The problem of high recurrence rate after OLT for HCCA has not been solved yet.
authors.affiliation: Institutes of Hepatobiliary Surgery of Chinese People's Liberation Army, General Hospital of Chinese People's Liberation Army, Beijing 100853, China. zhounx301@163.com
authors.forename: Ning-xin
authors.initials: NX
authors.lastname: Zhou
authors.forename: Zhi-qiang
authors.initials: ZQ
authors.lastname: Huang
authors.forename: Wen-zhi
authors.initials: WZ
authors.lastname: Zhang
authors.forename: Xiao-qiang
authors.initials: XQ
authors.lastname: Huang
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Rong
authors.initials: R
authors.lastname: Liu
authors.forename: Wen-bin
authors.initials: WB
authors.lastname: Ji
authors.forename: Mei
authors.initials: M
authors.lastname: Xiao
authors.forename: Xiang-fei
authors.initials: XF
authors.lastname: Meng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D002681:China; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome