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Hepatic Resection of the Intraductal Papillary Type of Peripheral Cholangiocarcinoma

From the Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

Correspondence: Address correspondence and reprint requests to: Yi-Yin Jan, MD, FACS, Department of Surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan; Fax: 886-3-328-5818; E-mail: ycn{at}adm.cgmh.org.tw

Background: Peripheral cholangiocarcinoma (PCC) can be grossly classified into mass-forming, periductal-infiltrating, and intraductal papillary (IP) types. Information on IP-PCC patients undergoing hepatectomy is sparse because of the small number of cases.

Methods: The clinical features of 40 IP-PCC patients undergoing hepatectomy between 1977 and 2000 were reviewed. The clinical features of 94 PCC patients without IP growth undergoing hepatectomy were used for comparison.

Results: IP-PCC and non–IP-PCC groups had similar age distributions (P = .674), sex ratios (P = .079), and positive rates for serum carcinoembryonic antigen and CA 19-9 (P = .121 and .795, respectively). The two groups also exhibited similar rates of association between hepatolithiasis and PCC (P = .230). However, more IP-PCC patients exhibited signs during admission, and more had ALT values >36 IU/L; they also had smaller tumors, more mucobilia association, and tumors in earlier stages and had undergone more postoperative chemotherapy. Multivariate logistic regression analysis showed that only ALT >36 IU/L differentiated IP-PCC from non–IP-PCC patients. The two groups exhibited similar operative mortality (P = 1.0). Follow-up ranged from 1.6 to 125.2 months (mean and median, 44.6 and 5.7 months, respectively). The 1-, 3-, and 5-year overall survival rates were 72.9%, 41.2%, and 24.7%, respectively, in the IP-PCC group and 43.3, 6.03%, and 2.01% in the non–IP-PCC group. The prognosis was favorable for the IP-PCC patients (P < .00001), particularly for IP-PCC patients who received curative hepatectomy (P = .013).

Conclusions: IP-PCC patients had significantly better survival than non–IP-PCC patients, and aggressive curative hepatic resection is associated with a longer survival.

Key Words: Hepatic resection • Intraductal papillary type • Peripheral cholangiocarcinoma

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				C.-N. Yeh, Y.-Y. Jan, and M.-F. Chen Hepatectomy for Peripheral Cholangiocarcinoma in Elderly Patients Ann. Surg. Oncol., December 1, 2006; 13(12): 1553 - 1559. [Abstract] [Full Text] [PDF]