The Surgical Treatment Of Hilar Cholangiocarcinoma And The Correlation Between Preoperative CA19-9Levels With Pathological Stage And Lymph Node Metastasisl

Hilar cholangiocarcinoma is an uncommon neoplasm arising from the biliaryconfluence or the right or left hepatic ducts. Treatment for hilar cholangio-carcinoma has remained challenging because of the lack of effective adjuvanttreatment. In addition, the ability to achieve complete resection is often limited bythe locally advanced nature of the tumor at presentation. Many patients with hilarcholangiocarcinoma are not candidates for radical resection. For these patients, theprimary goal of therapy is to palliate the effects of biliary obstruction.Purpose: To compare and analysis the survival rate of the five treatmentcommonly used to treat Hilar cholangiocarcinoma in our department （radicalresection；palliative resection；Bridge form internal drainage；through the tumorintubation and outside bridge form drainage；PTCD). We can choose moreappropriate treatment through comparison and analysis to improve the quality oflife and prolong survival time for the patients. To put forward guiding Suggestionsfor clinical works. At the same time, the preoperative CA19-9levels of the patientsin different pathological stage and with or without lymph node metastasis werecompared to explore the correlation between preoperative CA19-9levels withpathological stage and lymph node metastasis.Methods: Collect and arrangement121patients’materials between2006.01and2009.12that surgical treatment for HC. According to the different ways ofoperation we can divided into: radical resection group(44cases); palliativeresection group(8cases); Through the tumor intubation and outside bridge formdrainage group (18cases)；Bridge form internal drainage group (25cases);PTCDgroup(26cases)；Analyse the survival rate and draw the survival curves of each groups. Analysis the preoperative CA19-9level of46cases of patients withdifferent pathological stage,also the preoperative CA19-9level of lymph nodemetastasis group and without lymph node metastasis group.Then to analyse thedata into statisticas.Result: The survival rates of0.5,1,and2-year in post-radical resection were97.7%,88.3%, and57.1%, which were higher than other4groups (P<0.05). Thesurvival rates of0.5,1,and2-year in bridge form internal drainage group andthrough the tumor intubation and outside bridge form drainage group were65.8%,1305%,0, and65.7%,10.3%,0, which was just the same(p>0.05). The PTCD wastaken in patients who can not tolerate surgery. The preoperative CA19-9levels isassociated with the pathological stage. The median preoperative CA19-9levelsincreased with increasing pathological stage, and the preoperative CA19-9level ishigher in patients with lymph nodes metastasis than in patients without lymphnodes metastasis.Conclusion:1. Radical resection is the best surgical treatment for HC.Thesurvival rate of Radical resection group is higher than palliative resection group，Bridge form internal drainage group；through the tumor intubation and outsidebridge form drainage and PTCD.2. There is no significant difference in survivalrate between bridge form internal drainage group with through the tumorintubation and outside bridge form drainage.3. The preoperative CA19-9level isassociated with the pathological stage. The preoperative CA19-9level increasedwith increasing pathological stage.4. The preoperative CA19-9level is muchhigher in patients with lymph nodes metastasis than in patients without lymphnodes metastasis.