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10.1245/s10434-007-9687-y
Annals of Surgical Oncology 15:590-599 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Prognosis of Perihilar Cholangiocarcinoma: Hilar Bile Duct Cancer versus Intrahepatic Cholangiocarcinoma Involving the Hepatic Hilus

Tsuyoshi Sano, MD1, Kazuaki Shimada, MD1, Yoshihiro Sakamoto, MD1, Hidenori Ojima, MD2, Minoru Esaki, MD1 and Tomoo Kosuge, MD1

1 Hepato-Biliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
2 Pathology Division, National Cancer Center Research Institute, Tokyo, Japan

Correspondence: Address correspondence and reprint requests to: Tsuyoshi Sano, MD; E-mail: tsusano{at}aichi-cc.jp

Background: Clinically hepatobiliary resection is indicated for both hilar bile duct cancer (BDC) and intrahepatic cholangiocarcinoma involving the hepatic hilus (CCC). The aim of this study was to compare the long-term outcome of BDC and CCC.

Methods: Between 1990 and 2004, we surgically treated 158 consecutive patients with perihilar cholangiocarcinoma. The clinicopathological data on all of the patients were analyzed retrospectively.

Results: The overall 3-year survival rate, 5-year survival rate, and median survival time for BDC patients were 48.4%, 38.4 %, and 33.7 months, respectively, and 35.8%, 24.5 %, and 22.7 months, respectively, in CCC patients (P = .033).

On multivariate analysis, three independent factors were related to longer survival in BDC patients: achieved in curative resection with cancer free margin (R0) (P = .024, odds ratio 1.862), well differentiated or papillary adenocarcinoma (P = .011, odds ratio 2.135), and absence of lymph node metastasis (P < .001, odds ratio 3.314). Five factors were related to longer survival in CCC patients: absence of intrahepatic daughter nodules (P < .001, odds ratio 2.318), CEA level ≤2.9 ng/mL (P = .005, odds ratio 2.606), no red blood cell transfusion requirement (P = .016, odds ratio 2.614), absence or slight degree of lymphatic system invasion (P < .001, odds ratio 4.577), and negative margin of the proximal bile duct (P = .003, odds ratio 7.398).

Conclusions: BDC and CCC appear to have different prognoses after hepatobiliary resection. Therefore, differentiating between these two categories must impact the prediction of postoperative survival in patients with perihilar cholangiocarcinoma.

Key Words: Hilar bile duct cancer • Intrahepatic cholangiocarcinoma • Hepatobiliary resection






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