title: Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients.
abstract: OBJECTIVE
  To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma.
  
  
  METHODS
  Retrospective multicenter study including 17 Italian hepatobiliary surgery units.
  
  
  METHODS
  A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007.
  
  
  METHODS
  Postoperative mortality, morbidity, overall survival, and disease-free survival.
  
  
  RESULTS
  Postoperative mortality and morbidity after liver resection were 10.1% and 47.6%, respectively. At multivariate logistic regression, extent of resection (right or right extended hepatectomy) and intraoperative blood transfusion were independent predictors of postoperative mortality (P = .03 and P = .006, respectively); in patients with jaundice, mortality was also higher without preoperative biliary drainage than with biliary drainage (14.3% vs 10.7%). During the study period, there was an increasingly aggressive approach, with more frequent caudate lobectomies, vascular resections, and resections for advanced tumors (T stage of 3 or greater and tumors with poor differentiation). Despite the aggressive approach, the blood transfusion rate decreased from 81.0% to 53.2%, and mortality slightly decreased from 13.6% to 10.8%. Median overall survival significantly increased from 16 to 30 months (P = .05). At multivariate analysis, R1 resection, lymph node metastases, and T stage of 3 or greater independently predicted overall and disease-free survival.
  
  
  CONCLUSIONS
  Surgery for hilar cholangiocarcinoma has improved with decreased operative risk despite a more aggressive surgical policy. Long-term survival after liver resection has also increased, despite the inclusion of cases with more advanced hilar cholangiocarcinoma. Preoperative biliary drainage was a safe strategy before right or right extended hepatectomy in patients with jaundice. Pathologic factors independently predicted overall and disease-free survival at multivariate analysis.
authors.affiliation: Hepatobiliary Surgery Unit, A. Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardito
authors.forename: Ivo
authors.initials: I
authors.lastname: Giovannini
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bresadola
authors.forename: Fulvio
authors.initials: F
authors.lastname: Calise
authors.forename: Raffaele
authors.initials: R
authors.lastname: Dalla Valle
authors.forename: Davide F
authors.initials: DF
authors.lastname: D'Amico
authors.forename: Leandro
authors.initials: L
authors.lastname: Gennari
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Giulini
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guglielmi
authors.forename: Elio
authors.initials: E
authors.lastname: Jovine
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pellicci
authors.forename: Heinrich
authors.initials: H
authors.lastname: Pernthaler
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
authors.forename: Stefano
authors.initials: S
authors.lastname: Puleo
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Massimo
authors.initials: M
authors.lastname: Ferrucci
authors.forename: Laura
authors.initials: L
authors.lastname: Mastrangelo
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitanò
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruzzenente
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scuderi
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome