Outcomes after curative resections of cholangiocarcinoma

D. M. Nagorney, J. H. Donohue, M. B. Farnell, C. D. Schleck and D. M. Ilstrup
Department of Gastroenterologic and General Surgery, Rochester, Minn.

OBJECTIVES: To elucidate the clinical and pathologic features of extrahepatic cholangiocarcinomas and to identify prognostic variables in patients treated surgically. DESIGN: Retrospective review of clinical records of patients undergoing surgical exploration for cholangiocarcinoma, with univariate and multivariate analyses of the clinical and pathologic factors that influenced patient survival. SETTING: Mayo Clinic, Rochester, Minn. STUDY PARTICIPANTS: One hundred seventy-one patients undergoing operative intervention for diagnostic, palliative, or curative reasons between 1976 and 1985. Follow-up was complete until death or for a minimum of 5 years for surviving patients. INTERVENTION: A curative surgical resection was performed in 29% of patients, while the remainder underwent tumor biopsy or a palliative procedure. MAIN OUTCOME MEASURE: Patient survival following operative treatment. RESULTS: The operative mortality in this patient cohort was 5% and median survival was 13 months. Overall 5-year survival was 16%, with 44% of patients having a curative resection still alive at 5 years. Using univariate analysis, curative resection, tumor stage, Eastern Cooperative Oncology Group performance status, total bilirubin concentration, lymph node status, liver invasion, tumor morphology, tumor grade, and site of tumor origin were significant determinants of prognosis. Using the Cox proportional hazards model for multivariate analysis, curative resection, Eastern Cooperative Oncology Group performance status, total bilirubin concentration, and tumor grade were the only variables predictive of patient outcome. A curative resection of a proximal cholangiocarcinoma had a similar chance of providing long-term survival as a curative distal ductal resection. CONCLUSIONS: Although the tumor extent and the patient's overall health will affect outcome, curative resection for cholangiocarcinoma at all sites should be undertaken since this treatment offers the best chance for long-term survival.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Extrahepatic Bile Duct Adenocarcinoma: Patients at High-Risk for Local Recurrence Treated with Surgery and Adjuvant Chemoradiation Have an Equivalent Overall Survival to Patients with Standard-Risk Treated with Surgery Alone
Borghero et al.
Ann. Surg. Oncol. 2008;15:3147-3156.
ABSTRACT | FULL TEXT  

Peripheral Mass Forming Cholangiocarcinoma in Cirrhotic Liver
Kim et al.
Am. J. Roentgenol. 2007;189:1428-1434.
ABSTRACT | FULL TEXT  

Distal Bile Duct Carcinoma: Prognostic Factors After Curative Surgery. A Series of 112 Cases
Cheng et al.
Ann. Surg. Oncol. 2007;14:1212-1219.
ABSTRACT | FULL TEXT  

Surgical Oncology
Espat and Sharif
Integr Cancer Ther 2006;5:132-134.
 

Delayed-Phase Dynamic CT Enhancement as a Prognostic Factor for Mass-forming Intrahepatic Cholangiocarcinoma
Asayama et al.
Radiology 2005;238:150-155.
ABSTRACT | FULL TEXT  

Diagnosis and Treatment of Cholangiocarcinoma
Anderson et al.
The Oncologist 2004;9:43-57.
ABSTRACT | FULL TEXT  

G Protein {gamma}7 Expression as a New Clinicopathological Marker in Patients With Intrahepatic Cholangiocarcinoma
Utsunomiya et al.
Arch Surg 2002;137:181-185.
ABSTRACT | FULL TEXT  

Prognostic Factors After Pancreatoduodenectomy With Extended Lymphadenectomy for Distal Bile Duct Cancer
Yoshida et al.
Arch Surg 2002;137:69-73.
ABSTRACT | FULL TEXT  

Surgical Treatment and Outcomes in Carcinoma of the Extrahepatic Bile Ducts: The University of Rochester Experience
Blom and Schwartz
Arch Surg 2001;136:209-214.
ABSTRACT | FULL TEXT