Aggressive Surgical Resection for Cholangiocarcinoma
- 1 March 1995
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Surgery
- Vol. 130 (3), 270-276
- https://doi.org/10.1001/archsurg.1995.01430030040006
Abstract
Objectives: To review the spectrum of cholangiocarcinoma in patients treated by a single team of hepatobiliary surgeons over an 8-year period, to evaluate the predictors of survival, and to assess the results of an aggressive approach to surgical resection. Design: Retrospective review of all clinical records of patients referred for treatment of cholangiocarcinoma, with univariate analysis of clinical and pathologic factors in relation to patient survival. Setting: New England Deaconess Hospital, Boston, Mass. Patients: Eighty-eight consecutive patients referred with the established diagnosis of cholangiocarcinoma, from December 31, 1985, to April 15, 1994. Interventions: Seventy-five of 88 patients were treated surgically, with 59 undergoing major resection for cure. Of the 29 patients treated palliatively, 16 had operations and 13 had wire mesh stents placed nonoperatively. Main Outcome Measures: Morbidity, mortality, and patient survival. Results: Survival correlates directly with the pathologic stage (TNM). Tumor location had no impact on survival. Patients undergoing resection survived significantly longer (median, 23.2 months) than palliated patients (median, 7.7 months; P=.0015). Nonoperative palliation resulted in better survival than surgical palliation (P=.045). Major hepatic resection was used alone in eight patients with predominating intrahepatic lesions, while 18 patients with hilar lesions underwent en bloc skeletonization in conjunction with major hepatic resection. Resection with microscopically free margins significantly improved survival. Only patients undergoing major resection enjoyed survival greater than 2 years. Conclusions: Patient survival can be significantly improved by aggressive surgical resection. Hepatic resection should be used aggressively to achieve disease-free margins to optimize survival. Hepatic resection can be performed with low morbidity and mortality. Liver transplantation should be avoided as a treatment for cholangiocarcinoma. The best palliation for unresectable disease remains debatable. We advocate nonoperative treatment with endobiliary expandable wire mesh stents for patients with unresectable disease. (Arch Surg. 1995;130:270-276)This publication has 11 references indexed in Scilit:
- Carcinoma of the Extrahepatic Bile Ducts The University of California at San Francisco ExperienceAnnals of Surgery, 1994
- Percutaneously placed Wallstent endoprosthesis in patients with malignant distal biliary obstructionBritish Journal of Surgery, 1993
- Outcomes After Curative Resections of CholangiocarcinomaArchives of Surgery, 1993
- Improvements in Survival by Aggressive Resections of Hilar CholangiocarcinomaAnnals of Surgery, 1993
- Management Strategies in Resection for Hilar CholangiocarcinomaAnnals of Surgery, 1992
- Surgical Management of 552 Carcinomas of the Extrahepatic Bile Ducts (Gallbladder and Periampullary Tumors Excluded)Annals of Surgery, 1991
- Management of Proximal cholangiocarcinomas by surgical resection and radiotherapyThe American Journal of Surgery, 1990
- Major Liver Resection for Hilar CholangiocarcinomaAnnals of Surgery, 1988
- Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancerWorld Journal of Surgery, 1988
- Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis: An unusual tumor with distinctive clinical and pathological featuresAmerican Journal Of Medicine, 1965