Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jul;13(7):483-93.
doi: 10.1111/j.1477-2574.2011.00328.x.

Evolution of the surgical management of perihilar cholangiocarcinoma in a Western centre demonstrates improved survival with endoscopic biliary drainage and reduced use of blood transfusion

Alastair L Young  1 , Tsuyoshi Igami, Yoshiki Senda, Robert Adair, Shahid Farid, Giles J Toogood, K Rajendra Prasad, J Peter A Lodge
Affiliations

Evolution of the surgical management of perihilar cholangiocarcinoma in a Western centre demonstrates improved survival with endoscopic biliary drainage and reduced use of blood transfusion

Alastair L Young et al. HPB (Oxford). 2011 Jul.

Abstract

Background: Perihilar cholangiocarcinoma (PHCCA) remains a surgical challenge for which few large Western series have been reported. The aims of this study were to investigate the results of surgical resection for PHCCA and assess how practice has evolved over the past 15 years.

Methods: A prospectively maintained database was interrogated to identify all resections. Clinicopathological data were analysed for impact on survival. Subsequently, data for resections carried out during the periods 1994-1998, 1999-2003 and 2004-2008 were compared.

Results: Eighty-three patients underwent resection. Trisectionectomy was required in 67% of resections. Overall survival was 70%, 36% and 20% at 1, 3 and 5 years, respectively. Size of tumour, margin (R0) status, lymph node status, distant metastasis, tumour grade, portal vein resection, microscopic direct vascular invasion, T-stage and blood transfusion requirement significantly affected outcome on univariate analysis. Distant metastasis (P = 0.040), percutaneous biliary drainage (P = 0.015) and blood transfusion requirement (P = 0.026) were significant factors on multivariate analysis. Survival outcomes improved and blood transfusion requirement was significantly reduced in the most recent time period.

Discussion: Blood transfusion requirement and preoperative percutaneous biliary drainage were identified as independent indicators of a poor prognosis following resection of PHCCA. Longterm survival can be achieved following the aggressive surgical resection of this tumour, but the emergence of a clear learning curve in our analyses indicates that these patients should be managed in high-volume centres in order to achieve improved outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan–Meier curves for overall survival in resected and unresected patients
Figure 2
Figure 2
Survival curves according to (A) distant metastasis (multivariate analysis, P = 0.040; hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.04–7.35), (B) percutaneous transhepatic biliary drainage (PTBD) (multivariate analysis, P = 0.015; HR 2.27, 95% CI 1.18–4.38) and (C) blood transfusion requirement (multivariate analysis, P = 0.026; HR 2.00, 95% CI 1.09–3.69)
Figure 3
Figure 3
Subgroup analysis by resection status, lymph node status and presence of distant metastasis. R0, microscopic curative resection; R1, macroscopic curative resection; R2, macroscopic non-curative resection; M0, absence of distant metastasis; M1, presence of distant metastasis; N0, absence of lymph node metastasis; N1, presence of lymph node metastasis
Figure 4
Figure 4
Kaplan–Meier survival curves for the three time periods analysed. Period 1: 1994–1998; Period 2: 1999–2003; Period 3: 2004–2008. Periods 1 vs. 2: P = 0.579; Periods 1 vs. 3: P = 0.225; Periods 2 vs. 3: P = 0.108
See this image and copyright information in PMC

References

    1. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet. 2005;366:1303–1314. - PubMed
    1. Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumours. Ann Surg. 1996;224:463–473. discussion 473–475. - PMC - PubMed
    1. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumour with distinctive clinical and pathological features. Am J Med. 1965;38:241–256. - PubMed
    1. Ebata T, Kamiya J, Nishio H, Nagasaka T, Nimura Y, Nagino M. The concept of perihilar cholangiocarcinoma is valid. Br J Surg. 2009;96:926–934. - PubMed
    1. Jonas S, Benckert C, Thelen A, Lopez-Hänninen E, Rösch T, Neuhaus P. Radical surgery for hilar cholangiocarcinoma. Eur J Surg Oncol. 2008;34:263–271. - PubMed

MeSH terms