Surgical treatment of hilar cholangiocarcinoma

Hilar cholangiocarcinoma is adenocarcinoma originating from mucosa of bile ducts at hilar region and for the treatment of hilar cholongicarcinoma, resection with negative surgical magrin is the only modality leading prolonged survival. In this study, 40 cases of surgically resected hilar cholangiocarcinoma at Çukurova University General Surgery Department between 1996 and 2007 were analysed retrospectively. Mean age of the cases was 54.7±10.2. Twenty five cases were male and 15 of them were female. According to Modified Bismuth Corlette classification, 15 cases were type 1, while 8 and 17 of cases were classified as type 3a and 3b, respectively. According to Burke proposed T staging system, 23, 4 and 13 of cases were classified as T1, T2 and T3, respectively. Biliary resection was carried out in 15 cases, while hepatic resection was performed in 25 cases. Among hepatic resections, pancreaticoduodenectomy, antrectomy and caudate lobectomy were performed to 1, 1 and 10 cases, respectively. Hepatectomy procedures: right hepatectomy (5 cases), left hepatectomy (6cases), extended right hepatectomy (3 cases), extended left hepatectomy (1 case), extended left hepatectomy with caudate lobectomy (1 case) and left hepatectomy with caudate lobectomy (9 cases). According to histopathologic examination, 9 cases were assessed as grade 1, while 22 and 9 cases were assessed as grade 2 and 3, respectively. There were tumoral infiltration of bile duct serosa in 19 cases, hilar lymph node metastasis (N1) in 9 cases, vascular invasion in 10 cases, lymphatic invasion in 7 cases, liver invasion in 14 cases, antral invasion in one and pancreatic invasion in one case. R0 resection was performed in 35 cases. Number of cases according to TNM grading system was demonstrated as following; Stage 1a: 6 cases, Stage 1b: 12 cases, Stage 2a: 12 cases, Stage 2b: 9 cases, Stage 3: 1 case. Early postoperative morbidity and mortality rates were 45% and 17.5%, respectively. Early morbidity and mortality rates were %56 and %20 repectively. In long term follow up, morbidity and mortality rates were 72% and 66.6%, respectively. Among cases underwent hepatic resection, local and distant metastasis were observed in longer time and in lower rates. Median survival was 30 months, while 1 year, 3 year and 5year survival rates were 87%, 44% and 7% respectively. Median survival was 42 months and 5year survival rate was15% in cases of hepatic resection. These parameters were higher than the cases of biliary resection. Resection type, resection with negative margin (R0 resection) and perineural invasion were found to be prognostic factors associated with survival (p<0.05). Despite having higher grade, late survival rates in cases of hepatic resection were higher, while local and distant recurrence rates were lower. In conclusion, hepatic resection is defined as standard curative surgical modality in treatment of hilar cholangiocarcinoma because of providing higher R0 recection rates.