Peripheral cholangiocarcinoma(PCC) is defined as a malignancy of intrahepatic bile duct presenting as a focal liver mass, specifically, those located peripheral to the 2nd-order branchings of the bile duct. During the study period of 11 years
from
Jan.
1985 through Dec. 1995, a total of 12 patients underwent liver resection for PCC at the Department of Surgery, Inje University Paik Hospital, Seoul. This figure accounts for 8.3% of primary liver cancer. There were 9 men and 3 women with a ratio
of
3:1,
the mean age was 53.3 years with a range of 39 to 67 years. twenty-five per cent of the patients had concomitant intrahepatic stone(IHS). HBsAg was positive in one case(8.3%) who had chronic hepatitis. No patient had liver cirrhosis. The accurate
preoperative diagnosis of PCC in 3 cases was difficult because of the association with IHS. These 3 patients underwent surgery under the diagnosis of chronic cholangitis rather than PCC. CEA and CA 19-9 were elevated in 70% and 50% of the
patients,
respectively. In most concomitant measurement of CEA and AFP facilitated the differentiation between PCC and hepatocellular carcinoma. as to the tumor characteristics, 83% of the patients had tumors greater than 5 cm in diameter, indicating the
advanced
stage of the tumor at the time of resection. The site of origin of tumor mass was distributed more or less evenly between the hepatic lobes. The patients with mass-forming, expanding type of tumors made up 58% of the cases, infiltrating type 25%,
and
the remainder being the combination of both. A significant number of patients, 27%, had nodal metastasis.
Two thirds of the patients underwent major hepatic resections. Segmentectomies here include the resection of lateral segment done as a treatment for IHS, which later proved to be cancer on histologic examination. There was no operative death
among
the
12 patients. The overall median survival time was 12 months. The overall survival rates at 1, 3, and 5 years were 42.4%, 42.4%, and 42.4%, respectively. Only the radicality of the resection was the statistically significant risk factor for
survival
by
univariate analysis. The 5-year survival rate was 100% in 6 patients who had curative resection(no lymph node invasion, no peritoneal seeding, clear resection margin).
The prognosis of patients with advanced PCC is unfavorable unless the tumors is entirely removed. In view of the association of IHS in a significant portion of the cases, the possible coexistence of the carcinoma should always be borne in mind
when
dealing with patients with IHS.
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