Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

Background

Hilar cholangiocarcinoma (HCCA) is a challenging problem for surgeons because surgery is the only effective therapy for these patients. In this study, we review 15 years of HCCC cases and treatment at a single Egyptian center.

Methods

From January 1995 to October 2010, 825 patients with HCCC were referred to Gastroenterology Surgical Center, Mansoura University, Egypt.  From those 243 underwent potentially curative resection giving respectability rate of 29.4%, and the remaining patients (70.6%) underwent non-surgical treatment because of advanced disease, advanced cirrhosis, poor general condition and distant metastasis and locally advanced diseases. Data were recorded for the 243 cases (subjected to different types of hepatic resection), including demographics, medical history, presenting symptoms, and biochemical, radiological, and pathological parameters.

Results

The overall resectability rate of the patients studied was 29.4% (243/825). Localized resection, right hepatectomy, or left hepatectomy were  completed in 30.5%, 22.6%, and 46.9% respectively, and segment one in 58 % R0 status was achieved in 49.8% of patients. The overall complication rate was 35%. Operative mortality was 6.6% with a five-year survival rate of 16%. Recurrence occurred in 92 (37.8%) the site of recurrence was hepatic (24.3%) and local (13.5%). Resection margin (R0) (P<0.001), lymph node status (P<0.001) (negative), degree of differentiation (P<0.001), segment one resection (P<0.001) (positive), and status of liver (P<0.001) (normal or cirrhotic) predicted statistically higher survival (P<0.001). According to multivariate analysis, R0 lymph node status and well differentiated status. Prediction improved survival among all patients.

Conclusion

From these case studies, aggressive surgery with caudate lobe resection with normal liver parenchyma may produce better prognoses in patients with resectable HCCA.