title: Univariate and multivariate analysis of prognostic factors in the surgical treatment of hilar cholangiocarcinoma.
abstract: Surgery is the only effective treatment able to improve survival of patients with hilar cholangiocarcinoma (CCA). However, the significance of prognostic factors on overall survival is still debated. We evaluated early and long-term outcomes of patients resected for hilar cholangiocarcinoma over a 3-year period to determine the role of prognostic factors and their effect on overall survival. Medical records of patients with hilar CCA who underwent resection between January 2001 and December 2004 were retrospectively reviewed. Univariate and multivariate analysis was performed to identify prognostic factors associated with survival. Thirty-two of 45 patients underwent surgical resection with curative intent. Morbidity was 24.4 per cent; perioperative mortality was 0 per cent. Overall median survival was 22.3 months. Well-differentiated tumor grading and R0 resection were independently associated with better survival at multivariate analysis. Aggressive surgery, including biliary resection combined with major hepatectomy, is a safe procedure with low morbidity and mortality in a tertiary referral hepatobiliary center. The main aim of an aggressive surgical approach is to obtain a microscopic margin-negative resection, which is associated with better prognosis. Another important prognostic factor is tumor grading, which is independently associated with survival.
authors.affiliation: Department of General Surgery, Hepato-biliary-pancreatic Unit, University of Rome "La Sapienza," II School of Medicine, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bellagamba
authors.forename: Niccolò
authors.initials: N
authors.lastname: Petrucciani
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: Nicola
authors.initials: N
authors.lastname: Cautero
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Augusto
authors.initials: A
authors.lastname: Lauro
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D014408:Biomarkers, Tumor / Q000032:analysis; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor