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

Madariaga, JR and Iwatsuki, S and Todo, S and Lee, RG and Irish, W and Starzl, TE (1998) Liver resection for hilar and peripheral cholangiocarcinomas: A study of 62 cases. Annals of Surgery, 227 (1). 70 - 79. ISSN 0003-4932

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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.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Madariaga, JR
Iwatsuki, S
Todo, S
Lee, RG
Irish, W
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1998
Date Type: Publication
Journal or Publication Title: Annals of Surgery
Volume: 227
Number: 1
Page Range: 70 - 79
DOI or Unique Handle: 10.1097/00000658-199801000-00011
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0003-4932
Other ID: uls-drl:31735062133958, Starzl CV No. 1930
Date Deposited: 08 Apr 2010 17:32
Last Modified: 16 Oct 2017 05:55
URI: http://d-scholarship.pitt.edu/id/eprint/5316

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