Analysis Of Surgical Treatment And Prognosis Of121Patients With Hilar Cholangiocarcinoma

OBJECTIVE:The diagnosis and treatment of hilar cholangiocarcinoma is always difficult because of its complex anatomic location, low diagnosis rate in early stage, low rate of radical resection and high recurrence rate. This article aims to summarize our experience at the diagnosis and treatment of hilar cholangiocarcinoma.METHODS:We retrospectively analyzed the clinical data and prognosis of121patients with hilar cholangiocarcinoma treated in our department, from July2006to July2011, and found out the factors the influence the prognosis with statistical methods.RESULTS:Among these121patients,69patients underwent radical resection while22patients had palliative resection. The median survival time of radical group and palliative group were24months and13months. The5-year cumulative survival rates of radical group and palliative group were11%and0%respectively. Significant difference was found between the survival rates of these two groups (χ2=5.4, P=0.020). In the radical group,23.2%of the patients underwent radical resection with hepatectomy, whose median survival time was27.7months. There were9patients combined with left hemihepatectomy,5patients with right hemihepatectomy and2patients with left hemihepatectomy and caudate lobectomy. Among the105pathologic results, the median survival time and5-year survival rate of16patients with lymph nodes metastasis were8months and0%, while the median survival time and5-year survival rate of patients without lymph nodes metastasis were24months and9%. There was significant difference between the survival rates of these two groups (χ2=13.2, P<0.001). The5-year survival rate of group with nerve metastasis and group without nerve metastasis were5%and8%respectively, and there was no statistical difference between their survival rates (x2=0.188, P=0.665). Among the21patients with postoperative complications, only1patient (0.9%) died of hepatic failure, while the others recovered fully and discharged from hospital after best supportive care.CONCLUSIONS:The early diagnosis and treatment of hilar cholangiocarcinoma are important for improving the outcome of the patients. Operation is the main strategy, and radical resection is the best way that offers the possibility of long-term survival. Radical resection with extended hepatectomy can improve RO resection rate, but it needs fully preoperative preparation to reduce the postoperative complications and death rate.