Clinical Analysis Of Surgical Therapy For Cholangiocacinoma

Objective To make a comprehensive analysis of the clinical characteristics and the effect of different factors for the prognosis of cholangiocarcinoma patients; to summarize experience of surgical treatment of cholangiocarcinoma; to provide data, basis and reference instances of surgical therapy for cholangiocarcinoma in the future.Methods During January 2009 to December 2015,145 cases diagnosed as cholangiocarcinoma (CCA) were collected in our hospital and Lianyungang first people’s Hospital, to research the relationship between the histological differentiation, pathological staging, lymph node metastasis, surgery methods and the prognosis of CCA. The patients were followed-up by telephone or outpatient. The data were analyzed by using SPSS 18.0 software for statistical processing. The survival rate of the CCA patients were statistically analyzed by using Kaplan-Meier method, the Log-rank test method is used to contrast the survival curve.Results Descriptive results:This study has 145 cases with CCA.88 cases are hilar cholangiocarcinoma(HCC) patients, there were 56 males and 32 females, the patients aged from 31 to 86 years old, and the average age was 61.8+11.8 years old; 57 cases are distal cholangiocarcinoma, the patients aged from 36 to 82 years old, and the average age was 64.6+10.6 years old. The incidence of HCC by Longmire classification is higher, accounting for 60.7%. The proportion of Ⅲ-Ⅳ type is 67.0% by Bismuth-corlette classification. Among 53 cases with HCC accepted radical resection, among 34 cases accepted perhilar resection,28 cases received R0 resection,6 cases received R1 resection, the proportion of Bismuth-Corlette Ⅰ,Ⅱ,Ⅳ cases are more than Ⅲ type cases; 19 cases accepted radical resection on basis of hemihepatectomy, received R0 resection. Among 46 cases with distal cholangiocarcinoma accepted radical resection, all of them received R0 resection, surgical method was pancreaticoduodenal resection mostly. CCA mostly come from glandular epithelial tissue. Pathological stage of HCC in this study are mostly Ⅱ, Ⅲ stage, Bismuth-corlette Ⅲ cases are latest; pathological stage of distal cholangiocarcinoma in this study are mostly Ⅰ, Ⅱ stage.Follow-up results:74 cases were follow-up in this study, the average survival time was 23.9±2.2 months, the 1-,2-, and 3-year cumulative survival rates were 73.6%,39.1% and 25.7%. Distal cholangiocarcinoma average survival time is longer, prognosis is better by Longmire classification. Among cases with HCC, the prognosis of Bismuth-corlette Ⅰ is the best, Bismuth-corlette Ⅲ is the worst. The postoperation survival time of CCA patients with higher degree of histological differentiation, earlier pathologic stage, and negative lymph node metastasis is longer, the prognosis is better. Among cases with HCC, the differences of the survival rate between the group of radical resection on basis of hemihepatectomy and the group of perhilar resection are not statistic significance (p>0.05),but the rate of R0 resection between them has statistic significance (p<0.05).Conclusions 1) The prognosis of patients with distal cholangiocarcinoma is better.2) Tumor pathological stage, histological classification and lymph node metastasis are the factors to affect the postoperative survival time of patients with cholangiocarcinoma.3) Perhilar resection is suitable for patients with HCC of Bismuth-corlette Ⅰ-Ⅳ type, the radical resection on basis of hemihepatectomy is only suitable for patients with HCC of Bismuth-corlette Ⅲ type, but can significantly improve the rate of R0 resection.