Surgical Treatment And Prognostic Analysis Of Hilar Cholangiocarcinoma

ObjectiveTo make a comprehensive analysis of the clinical characteristics, surgical treatmentand prognostic factors of hilar cholangiocarcinoma, to strengthen the understanding ofHCC, to improve further the effect of the surgical therapy.MethodsDuring April1993to December2012,63cases diagnosed as hilar cholangi-ocarcinoma were collected in our hospital, to make the retrospective analyses of theclinical features, surgical methods and prognostic factors.21factors including sex, age,time of onset, clinical symptoms, complications, preoperative correlative laboratoryindexes, Bismuth type and modified T staging, surgical method, operation time, bleedingvolume, margin, lymph node metastasis, pathological type and degree of differentiation,postoperative chemotherapy and complications were analysed by univarite analysis usingKaplan-Meier method. Then, the prognostic factors were analysed by multivariate analysesusing Cox model.Results63cases with HCC were surgically treated in our hospital. There were45males and18females, and the ratio of male to female was2.5:1.The patients aged from40to83yearsold, and the average age was63.05±9.99years old, mainly concentrating on60～65agegroup. The most common clinical manifestation was skin and sclera jaundice, and thepercentage was88.9%(54/63). Among them, the painless evolutional jaundice accountedfor47.6%(30/63). Before surgery the average TBIL was309.02±191.77umol/L, and theaverage DBIL was187.76±126.27umol/L. According to Bismuth-Corlette typing method,the cases were classified as follows: type I in12.7%(n=8), type II in28.6%(n=18), typeⅢ a in9.5%(n=6), type Ⅲb in15.9%(n=10), type IV in33.3%(n=21). Among the63cases,39cases got surgical treatment. There were17cases of radical resection and22cases of palliative resection. Thus, the overall operation resection rate was61.9%(39/63), and the radical resection rate was43.6%(17/39). On the contrary,24cases gotnonoperative treatment. There were12cases of internal drainage,9cases of externaldrainage and3cases of simple exploratory laparotomy. The one-, two-, three-andfive-year survival rates were46.9%,20.4%,12.2%and6.1%in the overall group. Inaddition, the rate of one-, two-, three-and five-year survival for surgical resection was60.0%,33.3%,20.0%and10.0%. While, the rate of one-, two-, three-and five-yearsurvival for nonoperative resection was21.1%,0,0,0, respectively. Univarite analysesshowed that preoperative highest bilirubin, Bismuth classification and modified T staging,surgical method, margin, lymph node metastasis, pathological type and degree of different-iation were of statistically significant prognostic value. Multivariate analyses using Coxmodel showed that surgical method, lymph node metastasis, pathological type and degreeof differentiation were independent prognostic factors.Conclusion1. Surgical treatment can prolong the survival time of the patients with hilar cholangi-ocarcinoma and radical resection should be the preferred method due to its best treatmenteffect. In addition, simple drainage can improve the life quality of patients who can’treceive the resection.2. Preoperative highest bilirubin, Bismuth classification and modified T staging,surgical method, margin, lymph node metastasis, pathological type and degree of different-iation are of prognostic value. Among them, surgical method, lymph node metastasis,pathological type and degree of differentiation are independent prognostic factors.3. The radical resection rate can be improved by preoperative reasonable evaluation,selective preoperative biliary drainage and appropriately extended resection during thesurgery. Then, the prognosis of patients can be improved.