Preoperative evaluation with T-staging system for hilar cholangiocarcinoma.
OBJECTIVE
To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma.


METHODS
From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging.


RESULTS
The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage (P < 0.05). The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly (P < 0.001). Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection (28 mo vs 18 mo; P < 0.05). The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy (91.4% vs 68%; P < 0.05 ). And it was also higher in detecting port vein involvement (90% vs 54.5%; P < 0.05).


CONCLUSIONS
The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of long-term survival. MRCP/MRA coupled with color Doppler Ultrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.
Chen
Ru-Fu
RF
Department of Hepatobiliary Surgery, the Affiliated Second Hospital, Sun Yat-sen University, 107Yan-Jiang Xi Road, GuangZhou 510120, Guangdong Province, China.
Li
Zhi-Hua
ZH
Zhou
Jia-Jia
JJ
Wang
Jie
J
Chen
Ji-Sheng
JS
Lin
Qing
Q
Tang
Qi-Bing
QB
Peng
Ning-Fu
NF
Jiang
Zhi-Peng
ZP
Zhou
Quan-Bo
QB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology*; D001706:Biopsy; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D018616:Ultrasonography, Doppler, Duplex