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Resection of Hilar Cholangiocarcinomas: Pivotal Prognostic Factors and Impact of Tumor Sclerosis

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Abstract

The well-known poor prognosis of proximal bile duct cancer is due to its unfortunate anatomical location and its late diagnosis. Successful tumor resection, which is considered to be optimal treatment, depends on many factors. Eighty-eight patients suffering from proximal bile duct cancer underwent surgical exploration at our institution between 1977 and 1998. In 37 patients the tumor was resectable; in the remaining 51 patients exploratory laparotomy or a palliative operation was performed. The median survival after tumor resection was 18.6 months, but median survival after a palliative procedure or an exploratory laparotomy was only 3.4 months (p < 0.001). A curative R0 resection was possible in 11 patients, an R1 resection was performed in 22 patients, and 4 patients had an R2 resection. The median survival rate after R0 resection was 83.6 months, 12.3 months after R1 resection, and 2.7 months after R2 resection (p < 0.001). Survival after resection in patients with negative lymph nodes (n = 30) was significantly longer than in those with positive lymph nodes (n = 7) (p = 0.022). Grade of tumor sclerosis tended to have an influence on resectability rate (p = 0.076). The pattern of tumor growth was without statistical influence. Multivariate analysis revealed resection (p < 0.001) as the only significant prognostic marker for patient survival. Radical resection is the only therapy that provides a chance for long-term survival, with sclerosis of the cancer tending to have an influence on univariate analysis.

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Acknowledgments.

The authors thank Mr. Ernst M. Eigenbauer for technical assistance and Arpad Puhalla, M.D., for helpful criticism.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090, Austria

    Harald Puhalla M.D., Thomas Gruenberger M.D., Herwig Pokorny M.D., Thomas Soliman M.D., Thomas Winkler M.D. & Friedrich Laengle M.D.

  2. Division of Transplantation Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090, Austria

    Rudolf Steininger M.D. & Ferdinand Mühlbacher M.D.

  3. Department of Clinical Pathology, University of Vienna, Waehringer Guertel 18-20, A-1090, Austria

    Fritz Wrba M.D. & Ulrike Sponer M.D.

  4. Department of Medical Computer Science, University of Vienna, Waehringer Guertel 18-20, A-1090, Austria

    Meinhard Ploner M.S.

  5. Department of Medicine I, Division of Oncology, University of Vienna, Waehringer Guertel 18-20, A-1090, Austria

    Markus Raderer M.D.

Authors
  1. Harald Puhalla M.D.
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  2. Thomas Gruenberger M.D.
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  3. Herwig Pokorny M.D.
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  4. Thomas Soliman M.D.
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  5. Fritz Wrba M.D.
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  6. Ulrike Sponer M.D.
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  7. Thomas Winkler M.D.
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  8. Meinhard Ploner M.S.
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  9. Markus Raderer M.D.
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  10. Rudolf Steininger M.D.
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  11. Ferdinand Mühlbacher M.D.
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  12. Friedrich Laengle M.D.
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Correspondence to Harald Puhalla M.D..

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Puhalla, H., Gruenberger, T., Pokorny, H. et al. Resection of Hilar Cholangiocarcinomas: Pivotal Prognostic Factors and Impact of Tumor Sclerosis. World J. Surg. 27, 680–684 (2003). https://doi.org/10.1007/s00268-003-6656-x

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  • DOI: https://doi.org/10.1007/s00268-003-6656-x

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