title: Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution.
abstract: OBJECTIVE
  To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer.
  
  
  BACKGROUND
  The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series.
  
  
  METHODS
  We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival.
  
  
  RESULTS
  Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively.
  
  
  CONCLUSIONS
  R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.
authors: Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans Street, Baltimore, MD 21231, USA.
authors: Michelle L
authors: ML
authors: DeOliveira
authors: Steven C
authors: SC
authors: Cunningham
authors: John L
authors: JL
authors: Cameron
authors: Farin
authors: F
authors: Kamangar
authors: Jordan M
authors: JM
authors: Winter
authors: Keith D
authors: KD
authors: Lillemoe
authors: Michael A
authors: MA
authors: Choti
authors: Charles J
authors: CJ
authors: Yeo
authors: Richard D
authors: RD
authors: Schulick
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; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome