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

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