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KMID : 0870420030070010094
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2003 Volume.7 No. 1 p.94 ~ p.101
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Clinical Analysis of Hilar Cholangiocarcinoma: Focused on the Prognosis of Patients with Positive Resection Margin
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Choi Yun-Seung
Lee Kun-Young
Ahn Seung-Ick
Choi Sun-Keun
Heo Yoon-Seok
Song Eun-Seop
Kim Sei-Joong
Hong Kee-Chun
Shin Suk-Hwan
Woo Ze-Hong
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Abstract
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Background/Aims: Hilar cholangiocarcinoma is a tumor with poor prognosis although curative surgical resection is known to be the most effective treatment. To obtain negative resection margin is still a challenging problem for surgeons. We designed this study to investigate further the treatment strategies of the hilar cholangiocarcinoma by comparing the prognosis of patients managed by different modalities with special emphasis on the polarity of the resection margin.
Methods: A retrospective clinical study was performed at the Inha University Hospital patients managed for hilar cholangiocarcinoma from June 1996 to May 2002.
Results: The patients consisted of 45 men and 25 women. The average age of the patients was 66.4 years old. The survival rate for 1 year and 3 years and the median survival period were investigated. For the negative resection margin sub-group, those were 100%, 28.6% and 23 months respectively, while those for the positive resection margin sub-group were 70.6%, 10.8% and 19 months respectively. For the palliative bypass surgery sub-group, those were 0%, 0%, and 5 months, for the biliary stent sub-group, those were 5.3%, 0% and 5 months and for the intraductal radiotherapy sub-group, those were 20%, 0% and 7 months respectively. When the patients were divided between the resection and the non-resection groups, those figures were 79.2%, 12.1% and 20 months for the resection group while for the non-resection group, those were 11.9%, 0% and 6 months respectively. resection and the non-resection groups were different (p=0.0001). However, the survival difference for the negative and the positive resection margin sub-groups were insignificant (p=0.2401). For the three sub-groups of the non-resection group, the survival difference for each sub-groups were also insignificant (p=0.2979). Postoperative complication was observed in 12 patients (38.7%).
Three patients died and the postoperative mortality rate was 9.7%
Conclusion: To improve the survival of the hilar cholangiocarcinoma patients, it is believed that the best treatment is the aggressive resection of the tumor even if it is difficult to obtain negative resection margin. Considering the high morbidity and mortality rate of extensive surgery and comparable survival of the positive resection margin patients, further extension of the extent of resection to obtain negative resection margin should be performed in selected patients.
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KEYWORD
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Hilar cholangiocinoma, Resection margin
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