Liver resection for hilar and peripheral cholangiocarcinomas: a study of 62 cases

J R Madariaga, S Iwatsuki, S Todo, R G Lee, W Irish, T E Starzl, J R Madariaga, S Iwatsuki, S Todo, R G Lee, W Irish, T E Starzl

Abstract

Objective: To analyze a single center's 14-year experience with 62 consecutive patients with hilar (HCCA) and peripheral (PCCA) cholangiocarcinomas.

Summary background data: Long-term survival after surgical treatment of HCCA and PCCA has been poor.

Methods: From March 1981 until December 1994, 62 consecutive patients with HCCA (n = 28) and PCCA (n = 34) underwent surgical treatment. The operations were individualized and included local excision of the tumor and suprapancreatic bile duct, lymph node dissection, vascular reconstruction, and subtotal hepatectomy. Clinical and pathologic risk factors were examined for prognostic influence.

Results: Patients were followed for a median of 25 months (12-102 months). Postoperative morbidity and mortality (at 30 days) were 32% and 14%, respectively, for HCCA and 24% and 6% for PCCA. The survival rates for HCCA and PCCA were 79% (+/-8%) and 67% (+/-8%) at 1 year; 39% (+/-10%) and 40% (+/-9%) at 3 years; and 8% (+/-7%) and 35% (+/-10%) at 5 years, respectively. The median survival was 24 (+/-4) months for HCCA and 19 (+/-8) months for PCCA. The disease-free survival rates for HCCA and PCCA were 85% (+/-10%) and 77% (+/-9%) at 1 year; 18% (+/-11%) and 41% (+/-12%) at 3 years; and 18% (+/-11%) and 41% (+/-12%) at 5 years, respectively. Nearly 80% of these patients had TNM stage IV tumors. With HCCA, no risk factors were associated with patient survival. For PCCA, multiple tumors (relative risk [RR] = 3.5; 95% confidence interval [CI] = 1.2-10.5) and incomplete resection (RR = 8.3; 95% CI = 2.3-29.6) were independently associated with a worse prognosis. For HCCA, there was a trend for lower disease-free survival in females (p = 0.056; log rank test). For PCCA, tumor size >5 cm was the only factor associated with disease recurrence (p = 0.024; log rank test).

Conclusions: Even though rare, 5-year survival by resection can be achieved in both HCCA and PCCA, but new adjuvant treatments are clearly needed.

References

    1. Cancer Chemother Rep. 1966 Mar;50(3):163-70
    1. Semin Liver Dis. 1990 May;10(2):126-30
    1. Surg Gynecol Obstet. 1975 Sep;141(3):429-37
    1. Cancer. 1977 Jan;39(1):232-46
    1. Surg Gynecol Obstet. 1980 Feb;150(2):208-14
    1. Ann Surg. 1980 Jan;191(1):23-9
    1. Ann Surg. 1981 Oct;194(4):447-57
    1. Surg Gynecol Obstet. 1982 Jul;155(1):21-7
    1. J Pathol. 1983 Feb;139(2):217-38
    1. Arch Surg. 1983 Dec;118(12):1388-94
    1. Lancet. 1984 Jan 14;1(8368):66-70
    1. Cancer. 1984 Apr 1;53(7):1545-51
    1. Surg Clin North Am. 1985 Feb;65(1):59-78
    1. Semin Liver Dis. 1990 May;10(2):131-41
    1. World J Surg. 1990 Jul-Aug;14(4):535-43; discussion 544
    1. Surgery. 1990 Sep;108(3):572-80
    1. Ann Surg. 1992 Jan;215(1):31-8
    1. Surgery. 1992 Jun;111(6):617-22
    1. HPB Surg. 1992;5(2):95-101; discussion 101-2
    1. Surgery. 1994 Apr;115(4):445-51
    1. Semin Liver Dis. 1994 May;14(2):109-14
    1. Ann Surg. 1996 Apr;223(4):384-94
    1. Cancer. 1954 May;7(3):462-503
    1. AMA Arch Surg. 1957 Sep;75(3):450-60; discussion 460-1
    1. Am J Med. 1965 Feb;38:241-56
    1. Surg Annu. 1986;18:297-310
    1. Surgery. 1986 Mar;99(3):344-9
    1. Surg Gynecol Obstet. 1988 Feb;166(2):107-14
    1. Ann Surg. 1988 Feb;207(2):120-5
    1. World J Surg. 1988 Feb;12(1):48-51
    1. Cancer. 1988 Jun 15;61(12):2469-74
    1. Radiology. 1988 Oct;169(1):149-53
    1. Hum Pathol. 1988 Oct;19(10):1228-34
    1. Hepatogastroenterology. 1988 Dec;35(6):261-7
    1. Cancer. 1989 Aug 1;64(3):658-66
    1. Ann Surg. 1989 Sep;210(3):374-85; discussion 385-6
    1. Cancer. 1989 Dec 1;64(11):2226-32
    1. Surgery. 1990 Jun;107(6):597-604
    1. Surg Gynecol Obstet. 1975 Feb;140(2):170-8

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi