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KMID : 0870420010050010073
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2001 Volume.5 No. 1 p.73 ~ p.84
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Prognostic factors in the Surgical Treatment of Hilar Cholangiocarcinoma
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Lee Tae-Eel
Kim Jung-Chul
Cho Chol-Kyoon
Kim Hyun-Jong
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Abstract
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Background: Although much progress has been made in the management of hilar cholangiocarcinoma, long-term survival for most patients remains poor. The reasons of poor prognosis are due to mainly the difficulty of curative resection of the tumor, frequent postoperative recurrence and also the concomitant cholangitis, hyperbilirubinemia and impaired hepatic function resulted from progressive bile duct obstruction. In spite of many obstacles to surgical treatment for hilar cholangiocarcinoma, recent reports support that the surgical resection is the only promising way of treatment for better long-term survival. But there are still many problems and risks of high morbidity and mortality associated with the operation.
Aims: The appropriate selection of the patient for operation and the operation method by careful evaluation of the clinical status of the patient and the disease is very important for both improving the long-term survival and decreasing the postoperative complication.
Methods: This study was investigated to evaluate the prognostic factors in the surgical treatment of hilar cholagiocarcinoma which influence the postoperative morbidity and survival rate.
Results: 1) The postoperative complications were developed in 4 cases(11%) and 1 case of them was dead due to acute respiratory distress syndrome. The postoperative recurrence was observed in 6 cases(25%) and the recurred sites were local recurrences in 5 cases and bone metastasis in 1 case. Ten patients(41.7%) were dead and the causes of deaths were recurrence in 5 cases. Postoperative mean survival time was 16.46 months and 3, 7, 12 month cumulative survival rates were 84%, 67%, 51% respectively. 2) The clinicopathological factors including clinical findings, laboratory results and microscopic findings were not related significantly to the postoperative prognosis. 3) The mean survival time was 5.54 months in bile duct resection group and 26.2 months in bile duct resection with hepatic resection group. Ten month cumulative survival rate was 40% in bile duct resection group and 92.8% in bile duct resection with hepatc resection group, which means that the extent of resection is significantly related to survival rate(p=0.012).
Conclusion: Clinicopathological factors were not associated with the postoperative prognosis and the difference of operation type(extent of resection) was significantly related to the postoperative survival rate in the surgical treatment of hilar cholangiocarcinoma. The result suggests that more wide surgical resection including hepatic resection increases the possibility of curative resection and improve the long-term survival of the patient.
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KEYWORD
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Hilar cholangiocarcinoma, Operation type, Hepatic resection
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