Unbound MEDLINE

Surgical resection for hilar cholangiocarcinoma: experience improves resectability.

Abstract

OBJECTIVES
  In hilar cholangiocarcinoma, resection provides the only opportunity for longterm survival. A US experience of hilar cholangiocarcinoma was examined to determine the effect of clinical experience on negative margin (R0) resection rates.
METHODS
  We conducted a retrospective analysis of 110 consecutive hilar cholangiocarcinoma patients presenting over an 18-year period. Analyses were performed using chi-squared, Wilcoxon rank sum and Kaplan-Meier methods, and multivariable Cox and logistic regression modelling.
RESULTS
  Of the 110 patients in the cohort, 59.1% were male and 90.9% were White. The median patient age was 64 years. A total of 59 (53.6%) patients underwent resection; 37 of these demonstrated R0. The 30-day mortality rate was 5.1%; the complication rate was 39.0%. The rate of resectability increased over time (36.4% vs. 70.9%; P= 0.001), as did the percentage of R0 resections (10.9% vs. 56.5%; P < 0.001). Of the 59 patients who underwent resection, 23 (39.0%) experienced recurrence. Multivariable Cox regression analysis identified resection margins [hazard ratio (HR) = 4.124 for positive vs. negative; P= 0.002] and type of operation (HR = 5.075 for exploration vs. resection; P= 0.001) as significant to survival.
CONCLUSIONS
  Although R0 resection can be achieved in only a minority of patients, these patients have a reasonable chance of longterm survival. The last decade has seen a significant rise in rates of resectability of Klatskin's tumour at specialty centres.

Links

  • PMC Free PDF
  • PMC Free Full Text
  • Publisher Full Text
  • Authors

    Cannon RM, Brock G, Buell JF

    Source

    HPB : the official journal of the International Hepato Pancreato Biliary Association 14:2 2012 Feb pg 142-9

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Bile Duct Neoplasms
    Bile Ducts, Intrahepatic
    Biliary Tract Surgical Procedures
    Chi-Square Distribution
    Cholangiocarcinoma
    Clinical Competence
    Female
    Hepatic Duct, Common
    Humans
    Kaplan-Meier Estimate
    Kentucky
    Klatskin's Tumor
    Logistic Models
    Male
    Middle Aged
    Multivariate Analysis
    Ohio
    Proportional Hazards Models
    Retrospective Studies
    Risk Assessment
    Risk Factors
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Journal Article
    Multicenter Study

    Language

    eng

    PubMed ID

    22221577