Cholangiocarcinoma: a 7-year experience at a single center in Greece

Abstract

Aim: To evaluate survival rate and clinical outcome of cholangiocarcinoma.

Methods: The medical records of 34 patients with cholangiocarcinoma, seen at a single hospital between the years 1999-2006, were retrospectively reviewed.

Results: Thirty-four patients with a median age of 75 years were included. Seventeen (50%) had painless jaundice at presentation. Sixteen (47.1%) were perihilar, 15 (44.1%) extrahepatic and three (8.8%) intrahepatic. Endoscopic retrograde cholangiography (ERCP) and/or magnetic resonance cholangiography (MRCP) were used for the diagnosis. Pathologic confirmation was obtained in seven and positive cytological examination in three. Thirteen patients had co-morbidities (38.2%). Four cases were managed with complete surgical resection. All the rest of the cases (30) were characterized as non-resectable due to advanced stage of the disease. Palliative biliary drainage was performed in 26/30 (86.6%). The mean follow-up was 32 mo (95% CI, 20-43 mo). Overall median survival was 8.7 mo (95% CI, 2-16 mo). The probability of 1-year, 2-year and 3-year survival was 46%, 20% and 7%, respectively. The survival was slightly longer in patients who underwent resection compared to those who did not, but this difference failed to reach statistical significance. Patients who underwent biliary drainage had an advantage in survival compared to those who did not (probability of survival 53% vs 0% at 1 year, respectively, P = 0.038).

Conclusion: Patients with cholangiocarcinoma were usually elderly with co-morbidities and/or advanced disease at presentation. Even though a slight amelioration in survival with palliative biliary drainage was observed, patients had dismal outcome without resection of the tumor.

Figure 1

Comparison of baseline characteristics of the patients with respect to site. A: Age distribution with respect to site (intrahepatic, perihilar and extrahepatic) is significantly not different; B: Bilirubin values at presentation with respect to site (intrahepatic, and perihilar vs extrahepatic; P = 0.027).

Figure 2

Survival rates in different groups of patients according to treatment. A: Survival of all the 34 patients with cholangiocarcinoma; B: Survival rates of patients with cholangiocarcinoma, stratified by surgical (n = 4) or not surgical resection (n = 30) were not significantly different; C: Survival of patients with unresected cholangiocarcinoma among those who had any kind of biliary decompression (n = 26) and those who had no interventional therapy (n = 4, P = 0.038).