A Retrospective Study Of Perioperative Risk And Prognosis In Cholangiocarcinoma

Objective: To investigate the risk factors which influenced the perioperative mortality and morbidity , the prognosis after operation in cholangiocarcinoma.Methods: Sixty two patients with cholangiocarcinoma after operation were reviewed retrospectively, of which 33 men and 29 women with the age of 44 to 82 years (62.3±8.4) were included. Of the patients, 35 were upper-side cholangiocarcinoma , 6 were middle-side and 21 were lower-side. 18 were underwent radical resection, 19 palliative resection, 18 internal drainage, 5 external drainage and 2 laparotomy exploration.Logistic regression test was used in the perioperative mortality and morbidity study for multivariate analysis. In analysis of the risk factors influencing the prognosis, Cox regression proportional hazard model was used for multivariate analysis. Only patients with communication were entered Cox regression proportional hazard model. Before multivariate analysis, each parameter was evaluated with univariate analysis to define whether it was statistical significance (P<0.1) or not. Then the parameters with statistical significance entered for further multivariate analysis. Cumulative survival rate of patients with communication was calculated with Kaplan-Meier test. Survival curves were compared with Log-rank test.Fourteen parameters including sex, age, preoperative total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), r-glutamyltransferase (r-GGT), albumin, accompanied diseases, operative time and method, liver function classification, tumour stage and type were chosen to analysis the risk factors which were correlated to the perioperative mortality and morbidity. In study of the risk facters influencing the prognosis, however, 15 parameters were chosen, of which there were tumour stage and type and differentiation grade, residual resection margin, accompanied diseases, complication, and sex, age, preoperative total bilirubin, ALT, AST, ALP, r-GGT, albumin, liver function classification. The liver function was classified according to Child-pugh method and the tumor type was definded by Longmire classification, and the tumor stage was classified by UICC tumor stage standard.Results: In the study, 7 patients (11%) died perioperatively, of which there were 4 with multi-organ function failure, 1 with lung function failure, 1 with acute renal dysfunction and 1 with diabetes hyperosmolar coma. Complications occurred in 20 patients (32%), of whichthere were 4 with multi-organ function failure, 4 with bile leakage, 4 with bile duct infection , 3 with upper gastrointestinal bleeding, 3 with lung infection , 1 with diabetes hyperosmolar coma and 1 with acute renal dysfunction. 44 patients were followed up with the overall survival time of 3.1 to 41.8 months (12.7±8.1). Of the patients , 4 are still alive with the survival time from 14.7 to 41.8 months.Univariate analysis showed that the 7 factors might influence the perioperative mortality including age (P=0.006), preoperative total bilirubin (P=0.03), r-GGT (P=0.027), albumin (P=0.036), accompanied diseases (P=0.039), tumour stage (P=0.062), liver function classification (P=0.063)。In contrast, only age was related to the morbidity (P=0.025). In multivariate analysis, however, results showed that 3 factors significantly influenced the perioperative mortality, which in rank were age (P=0.01), tumour stage (P=0.049), r-GGT (P=0.046). The perioperative mortality was positively related to the patient age, tumour stage, r-GGT. Only patient age (P=0.025) was significantly related to the morbidity.Five factors might influenced the prognosis in univariate analysis including ALP (P=0.064), r-GGT (P=0.09), tumour stage (P=0.0001) and differentiation grade (P=0.028), residual resection margin (P=0.002). Multivariate analysis presented that 3 factors influenced significantly prognosis, which in rank were tumour stage (P=0.0001), tumour differentiation grade (P=0.006), residual resection margin (P=0.036). The prognosis was well in the patients with early tumour stage and higher tumour differentiation grade and margin- negative residual resection.Conclusion: (1) Age increase the perioperative mortality and morbidity risk, while high r-GGT and late tumour stage increase the morbidity risk. (2)The prognosis is well in the patients with cholangiocarcinoma at early tumour stage, higher tumour differentiation grade and margin-negative residual resection. Acquired early diagnosis and radical resection are the key to improve the prognosis in patients with cholangiocarcinoma.