Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma: 10-year single-institution experience.
BACKGROUND
The surgical resection of hilar cholangiocarcinoma is extremely challenging because the tumor is closely related with the complicated hilar structures. We investigated to identify the outcomes for patients who underwent surgical resection and to identify the parameters that influenced radical resection.


METHODS
From January 2000 to December 2009, 105 patients underwent surgical resection for hilar cholangiocarcinoma. The clinicopathological parameters and surgical outcomes were retrospectively analyzed.


RESULTS
There were 15 operative mortalities (14.3%). Seventy-four patients underwent curative resection (70.5%). The median overall survival time for R0, R1, and R2 were 58, 28, and 19 months, respectively. Caudate lobectomy (p = 0.044; odds ratio [OR], 4.386) and perineural invasion (p = 0.01; OR, 0.062) were correlated with curative resection. Total bilirubin levels of more than 3 g/dl just before the operation (p = 0.042; hazard ratio [HR], 2.109) and extent of resection (R1 and 2 vs R0; p = 0.05; HR, 2.309) were selected as significantly negative factors affecting overall survival on the multivariate analysis.


CONCLUSIONS
Caudate lobectomy and neurectomy may be thought of as adjustable territories by the surgeon's efforts to achieve curative resection. R0 resection achieved through those efforts and liver optimization using preoperative biliary drainage may offer the patients a chance of cure.
Department of Surgery, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Min Soo
MS
Cho
Sung Hoon
SH
Kim
Seung Woo
SW
Park
Jin Hong
JH
Lim
Gi Hong
GH
Choi
Joon Seong
JS
Park
Jae Bock
JB
Chung
Kyung Sik
KS
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome