Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma: A retrospective study of 5-year survivors

Abstract

Liver status, resection of caudate lobe, lymph node status, R0 resection and CA19-9 were demonstrated to be independent risk factors for long term survival.

Surgical Strategies for the Management of Perihilar Cholangiocarcinoma

“…Most patients with pCCA present with painless obstructive jaundice, which may be associated with vague abdominal pain, and weight loss. In about 10%, cholangitis is the initial presentation (6,16,17). On laboratory evaluation, pCCA patients show elevation of serum cholestatic parameters.…”

“…The role of preoperative biliary drainage (PBD) in pCCA patients remains a controversial issue. There is no proof that routine preoperative biliary drainage facilitates resection or reduces postoperative complication (6).…”

“…The main advantages of PBD are acquisition of a diagnostic cholangiogram to evaluate the disease extent and collection of brush samples from the biliary epithelium for cytologic analysis. In contrary, the use of biliary stents had been associated with higher incidence of postoperative infectious complications (6,24).…”

“…Among them, surgical margin status and lymph node metastases had been identified to be the most important prognostic factors affecting the survival (29,46). Other prognostic factors include liver status, extent of liver resection, caudate lobe resection, tumor differentiation, tumoral vascular invasion, perineural tumor infiltration, and adjuvant chemotherapy and radiation (6,35).…”

“…Radical resection of pCCA is one of the most challenging surgical procedures due to the close anatomic relationship of pCCA to major hepatic vascular structures with subsequent vascular invasion (4). However, pCCA carries a poor prognosis as more than 65% of the patients are presented with nonresectable disease at the time of diagnosis, and about 10% to 45% of patients are found to be unresectable after surgical exploration (5)(6)(7). Also, surgical resection is associated with substantial perioperative morbidity (4).…”