Changes in the surgical approach to hilar cholangiocarcinoma during an 18-year period in a Western single center

Giorgio Ercolani, Matteo Zanello, Gian Luca Grazi, Matteo Cescon, Matteo Ravaioli, Massimo Del Gaudio, Gaetano Vetrone, Alessandro Cucchetti, Giovanni Brandi, Giovanni Ramacciato, Antonio Daniele Pinna

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Liver resection is the only potential curative treatment for hilar cholangiocarcinoma. In this article, we evaluate mortality, survival, prognostic factors, and changes in surgical approach during the last two decades at a Western hepato-biliary center. Methods: Fifty-one patients undergoing liver resections constitute the study population. Patients undergoing palliative procedures were considered as a control group for comparison to the resected group. After 1997, a more aggressive surgical approach was applied that is based on the experience of Japanese surgeons. Results: Curative resections were achieved in 37 (72.5%) patients, and R1 resections were performed in 14 (27.5%). The overall 3- and 5-year survival rates were 47.3 and 34.1%, respectively. The 3- and 5-year survival rates were 38 and 19% in the R1 resection group, and 15% and 0 in the non-resected group, respectively. Univariate analysis revealed that lymph node and perineural invasion, R1 resection, and a bilirubin level >10 mg/dl affected long-term survival. Multivariate analysis showed that only perineural invasion was significant in affecting long-term survival. Univariate analysis showed that the mean preoperative bilirubin levels and mean blood transfusion were related to the mortality rate. The resectability rate significantly increased from 25 to 75.6% after 1997 following implementation of the new surgical approach. Conclusions: An aggressive surgical approach increases the resectability rate and may improve long-term survival even after R1 resection. Severe hyperbilirubinemia should be preoperatively drained, possibly by the percutaneous approach.

Original languageEnglish
Pages (from-to)329-337
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume17
Issue number3
DOIs
Publication statusPublished - May 2010

Keywords

  • Biliary tract
  • Cholangiocarcinoma
  • Hepatectomy
  • Prognosis
  • Treatment outcome

ASJC Scopus subject areas

  • Hepatology
  • Surgery
  • Medicine(all)

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