Analysis of the surgical outcome and prognostic factors for hilar cholangiocarcinoma: a chinese experience.

摘要

Purposes: Hilar cholangiocarcinoma (HC) is the most common location for bile duct cancer. It represents a significant technical challenge for surgical operation due to the close proximity to major vascular structures and to the liver and arborization of the right and left biliary tree. The objective of this study was to assess the therapeutic strategies and prognostic factors that could influence the clinical outcome of HC. Methods: From January 1990 to December 2009, a total of 215 HC patients undergoing resection were included in this study. Survival and follow-up were calculated from the date of initial histologic diagnosis to the dates of first recurrence or death and last contact, respectively. Uni- and multivariate analyses were performed to examine factors affecting clinical outcome and recurrence. Results: 215 patients underwent resection: 141 (65.6%) had an R0 resection (negative histologic margins), 46 (21.4%) had an R1 resection (positive histologic margins), 28 (13.0%) had an R2 resection. The 1-, 3- and 5-year cumulative survival rates (%) of the patients were 60.3, 37.2 and 29.7%. The median survival time after R0 resection was 47.1 months, 17.2 months after R1 resection, and 12.1 months after R2 resection. The results from univariate analyses suggest that poor histopathological grade (p = 0.004), lymph node metastasis (p = 0.000), vascular invasion (p = 0.005), neuroinvasion (p = 0.044), R1 resection (p = 0.000) and T2 or T3 stage (p = 0.009) were significant predictors for poor survival rates. By multivariate analysis, only the lymph node metastasis (RR = 2.450, 95% CI 1.677-3.579) and R1 resection (RR = 0.283, 95% CI 0.183-0.437) were significantly associated with poor survival rates. Conclusions: Negative histologic margins were associated with improved outcome after all HC resections. Complete resection remains the only therapy that offers the possibility of long-term survival, and hepatic resection is a critical component of the surgical approach.