Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications.
BACKGROUND
Surgery is the only potentially curative treatment for hilar bile duct cancer. This study sought to evaluate the efficacy and feasibility of surgical management of hilar bile duct carcinoma, including radical hepatectomy, at a single institution.


METHODS
We performed a retrospective review of 49 consecutive patients who underwent surgery at our hospital between 1990 and 2003.


RESULTS
Altogether, 44 of 49 patients underwent radical hepatectomy combined with caudate lobectomy and lymphadenectomy. One and four patients underwent partial hepatectomy or bile duct resection, respectively. No patients underwent preoperative portal vein embolization. The 5-year survival rate was 39.7%, with a median survival time of 3.75 years. The postoperative morbidity and mortality rates were 46.8% and 2.0%, respectively. Cox's proportional hazard model revealed that lymph node status and the residual tumor factor were independent prognostic factors. Multivariate analysis revealed that preoperative hyperbilirubinemia, postoperative complications, and extended surgical procedures were independently associated with postoperative hyperbilirubinemia. After potentially curative resection, 39.4% of patients suffered from disease recurrence. In 60% of the total cases, the sites of recurrence were distant metastases.


CONCLUSIONS
Surgery, including radical hepatectomy combined with caudate lobectomy and lymph node dissection, is a feasible, effective treatment for hilar bile duct cancer.
Hasegawa
Suguru
S
Department of Surgery, Kyoto University Hospital, Kyoto, Japan. shase@kuhp.kyoto-u.ac.jp
Ikai
Iwao
I
Fujii
Hideaki
H
Hatano
Etsuro
E
Shimahara
Yasuyuki
Y
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology / Q000401:mortality / Q000473:pathology; D008099:Liver / Q000473:pathology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality / Q000473:pathology; D018365:Neoplasm, Residual / Q000209:etiology / Q000401:mortality / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis