title: Impact of specialized multi-disciplinary approach and an integrated pathway on outcomes in hilar cholangiocarcinoma.
abstract: OBJECTIVE
  To assess the outcomes of patients with hilar cholangiocarcinoma following referral to a specialist multi-disciplinary team.
  
  
  METHODS
  Over an 11-year period, patients referred with hilar cholangiocarcinoma were identified from a prospectively maintained registry. Collated data included demographics, operative findings and histo-pathological data. Survival differences and prognostic factors were determined.
  
  
  RESULTS
  345 patients were referred with hilar cholangiocarcinoma, of which 57 (16.5%) patients had surgery. Prior to 2008, of 143 patients referred, only 17 (11.9%) patients underwent surgery, compared to 40 (19.8%) of 202 patients referred from 2008 onwards (p = 0.051). In the surgery group, the majority of patients underwent left hemi-hepatectomy (n = 19). In addition, portal vein (n = 5), hepatic artery (n = 2) and inferior vena cava (n = 3) resections were performed. The R0 resection rate was 73.7%. The morbidity and mortality rates were 59.6% and 14.0%, respectively. The median disease-free survival was 16 (4-101) months. The presence of lymph node metastasis (p = 0.002) was the only predictor of poorer disease-free survival. The 5-year overall survival was 39.5% and was significantly better than that of the palliative group (p < 0.001).
  
  
  CONCLUSIONS
  Surgery is the optimal treatment option for patients with hilar cholangiocarcinoma and is associated with better overall survival. Prompt referral to tertiary centres with a core team of clinicians to manage this difficult condition may allow more patients to come to potentially curative surgical resections.
authors.affiliation: North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L3 4FG, UK.
authors.forename: D
authors.initials: D
authors.lastname: Gomez
authors.affiliation: North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L3 4FG, UK.
authors.forename: P B
authors.initials: PB
authors.lastname: Patel
authors.affiliation: Department of Anaesthesia, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: C
authors.initials: C
authors.lastname: Lacasia-Purroy
authors.affiliation: North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L3 4FG, UK.
authors.forename: C
authors.initials: C
authors.lastname: Byrne
authors.affiliation: Department of Gastroenterology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: R P
authors.initials: RP
authors.lastname: Sturgess
authors.affiliation: Department of Oncology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: D
authors.initials: D
authors.lastname: Palmer
authors.affiliation: North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L3 4FG, UK.
authors.forename: S
authors.initials: S
authors.lastname: Fenwick
authors.affiliation: North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L3 4FG, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.affiliation: North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Liverpool L3 4FG, UK. Electronic address: Hassan.Malik@aintree.nhs.uk.
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000098:blood supply / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D033183:Interdisciplinary Communication; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010348:Patient Care Team; D011169:Portal Vein / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery
keywords: Cholangiocarcinoma; Hepatectomy; Hepatic resection; Hilar