title: Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival.
abstract: BACKGROUND
  Hilar cholangiocarcinoma (HC) is invariably fatal without surgical intervention. The primary aim of the current study was to report overall survival and recurrence-free survival outcomes after surgical resection of HC.
  
  
  METHODS
  Between December 1992 and December 2009, 85 patients were evaluated; of these, 42 patients underwent potentially curative surgery. These patients are the principal subjects of this study. Patients were assessed monthly for the first 3 months and then at 6-month intervals after treatment. Recurrence-free survival and overall survival were determined; 18 clinicopathologic and treatment-related factors associated with recurrence-free survival and overall survival were evaluated through univariate and multivariate analyses.
  
  
  RESULTS
  No patient was lost to follow-up evaluation. The median follow-up period was 20 months (range, 0-106 mo). The median recurrence-free survival and overall survival after resection was 15 and 28 months, respectively. The 5-year survival rate was 24%. Two factors were associated with overall survival: histologic grade (P = .002) and margin status (P = .033). Only histologic grade (P = .029) was associated with recurrence-free survival.
  
  
  CONCLUSIONS
  Surgical resection is an efficacious treatment for HC. Patient selection based on identified prognostic factors can improve treatment outcomes.
authors.affiliation: Department of Surgery, Hepatobiliary and Surgical Oncology Unit, University of New South Wales, St. George Hospital, Level 3 Pitney Building, Short St., Kogarah, New South Wales 2217, Sydney, Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Francis C
authors.initials: FC
authors.lastname: Chu
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D018365:Neoplasm, Residual / Q000175:diagnosis; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome