title: Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma: A retrospective study of 5-year survivors.
abstract: OBJECTIVE
  To determine predictors of long term survival after resection of hilar cholangiocarcinoma (HC) by comparing patients surviving > 5 years with those who survived < 5 years.
  
  
  METHODS
  This is a retrospective study of patients with pathologically proven HC who underwent surgical resection at the Gastroenterology Surgical Center, Mansoura University, Egypt between January 2002 and April 2013. All data of the patients were collected from the medical records. Patients were divided into two groups according to their survival: Patients surviving less than 5 years and those who survived > 5 years.
  
  
  RESULTS
  There were 34 (14%) long term survivors (5 year survivors) among the 243 patients. Five-year survivors were younger at diagnosis than those surviving less than 5 years (mean age, 50.47 ± 4.45 vs 54.59 ± 4.98, P = 0.001). Gender, clinical presentation, preoperative drainage, preoperative serum bilirubin, albumin and serum glutamic-pyruvic transaminase were similar between the two groups. The level of CA 19-9 was significantly higher in patients surviving < 5 years (395.71 ± 31.43 vs 254.06 ± 42.19, P = 0.0001). Univariate analysis demonstrated nine variables to be significantly associated with survival > 5 year, including young age (P = 0.001), serum CA19-9 (P = 0.0001), non-cirrhotic liver (P = 0.02), major hepatic resection (P = 0.001), caudate lobe resection (P = 0.006), well differentiated tumour (P = 0.03), lymph node status (0.008), R0 resection margin (P = 0.0001) and early postoperative liver cell failure (P = 0.02).
  
  
  CONCLUSIONS
  Liver status, resection of caudate lobe, lymph node status, R0 resection and CA19-9 were demonstrated to be independent risk factors for long term survival.
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abd ElWahab
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Ehab
authors.initials: E
authors.lastname: El Hanafy
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Sultan
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elghawalby
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Askr
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ali
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abd El Gawad
authors.affiliation: Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
keywords: CA19-9; Caudate lobe resection; Hepatic resection; Hilar cholangiocarcinoma; Liver cell failure