Clinical

Hepatic resection can extend survival in hilar cholangiocarcinoma

Last Updated: 2004-05-31 6:00:30 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Five-year survival in excess of 25% justifies the use of major partial hepatectomy, bile duct resection, and regional lymphadenectomy for patients with hilar cholangiocarcinoma, according to a report in the May issue of Archives of Surgery.

As senior author Dr. David M. Nagorney told Reuters Health, 5-year survival is achievable. "However, treatment of these patients is demanding and difficult and warrants management in specialty hepatobiliary centers."

Dr. Nagorney and colleagues at the Mayo Clinic College of Medicine, Rochester, Minnesota reviewed their experience with 46 such patients over 2 decades in an effort to determine factors related to patient survival.

Serious complications accompanied surgery in about half the patients (24 patients, 52%). These included transient liver failure in 5 patients and multiple complications in others.

Overall median survival was 2.3 years, and the actual 5-year survival rate was 26%. Seven patients are still alive a median 6.4 years after surgery.

Factors associated with poor overall survival included being male, having elevated direct bilirubin level at diagnosis, and a perioperative transfusion requirement that exceeded 4 units, the researchers note. In contrast, adjuvant therapy with chemotherapy and irradiation did not influence overall survival.

Half the patients experienced documented recurrence of hilar cholangiocarcinoma within a median of 3.6 years. Only high tumor grade was significantly associated with increased recurrence rate.

Dr. Nagorney added that he and his colleagues, "have been evaluating orthotopic liver transplantation for unresectable, non-metastatic hilar cholangiocarcinoma for several years," Although this has been beneficial in certain patients, he concluded, "organ allocation and extent of disease are major factors precluding liver transplantation as the procedure of choice."

Arch Surg 2004;139:514-525.