Clinical Aspect of Peripheral Cholangiocarcinoma: A Study of 7 Hepatectomy Cases

To clarify the features and problems presented by a peripheral cholangiocarcinoma (CCC), seven patients with hepatectomy from the First Department of Surgery, Nagasaki University School of Medicine (6 patients), and from Department of Surgery, National Ureshino Hospital (one patient) were reviewed. Men predominate with ratio of 5:2, and an average age was 65.4 years. Tumor location was left lateral segment in 4 patients, right lobe, middle lobe and posterior segment in one, respectively. Three patients were associated with hepatolithiasis. Underlying liver disease was found in 4 patients (57%); cirrhosis in 3 patients, and chronic hepatitis in one. Initial symptoms were abdominal pain, fever and palpable abdominal mass. In imaging modalities available, the detection rates of tumor were 100% in CT and 67% in US and angiography, respectively. Combination of MRI and CT clearly showed tumor characteristics. The serum CEA was slightly elevated in 5 patients (83%), but serum CA19-9 rose strikingly in 3 patients. Most tumors showed an infiltrating growth along intrahepatic bile duct, with a portal vein thrombus and/or satellite tumors frequently. In 3 patients, early recurrence with intrahepatic metastasis occured within the first 6 months. The patient of poorly differentiated adenocarcinoma containing a squamous or signet ring cell carinoma showed an extremely poor prognosis. This study suggests that early detection of small CCC and an extended resection are the most important factors for the survival of patient