title: Surgical treatment of 144 cases of hilar cholangiocarcinoma without liver-related mortality.
abstract: BACKGROUND
  The present study evaluated whether the short- and long-term outcomes improved during our 23 years of experience treating 144 consecutive patients with hilar cholangiocarcinoma.
  
  
  METHODS
  Patients treated between 1990 and 2000 (period 1; n = 70) were retrospectively compared with those treated between 2001 and 2012 (period 2; n = 74). Mortality and major complications were defined as any death occurring within 90 days of surgery and a grade III-IV complication according to the Clavien classification, respectively.
  
  
  RESULTS
  The mortality and major complication rates decreased from 1.2 and 34 % during period 1-0 and 24 % during period 2, respectively. Although the surgical procedure was comparable between the two periods, the median blood loss was significantly reduced from 1,020 mL during period 1-745 mL during period 2 (P = 0.003), and blood loss was the only significant predictor of postoperative morbidity in a multivariable analysis. The R0 resection rate (70 vs. 78 %, P = 0.250) and the 5-year survival rate (33 vs. 35 %, P = 0.529) were similar for the two periods. A multivariable analysis identified positive nodal involvement and R1-2 resection as independent prognostic factors for survival.
  
  
  CONCLUSIONS
  The perioperative outcomes after surgical treatment for hilar cholangiocarcinoma have steadily improved through the accumulation of experience and meticulous surgical techniques to reduce blood loss. Further improvement of the R0 resection rate could prolong patient survival.
authors.affiliation: First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Furusawa
authors.forename: Akira
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Takahide
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Akira
authors.initials: A
authors.lastname: Shimizu
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Motoyama
authors.forename: Sin-ichi
authors.initials: S
authors.lastname: Miyagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome