Prognosis After Surgery of Cholangiocarcinoma: Peripheral Intra-Hepatic Cholangiocarcinoma Versus Peri-Hilar Cholangiocarcinoma
Andrea Ruzzenente*1, Silvia Pachera1, Tommaso Campagnaro1, Alessandro Valdegamberi1, Paola Capelli2, Paola Nicoli1, Calogero Iacono1, Alfredo Guglielmi1
1Department of Surgery and Gastroenterology, University of Verona Medical School, Verona, Italy; 2Department of Pathology, University of Verona Medical School, Verona, Italy
Background. Cholangiocarcinoma is the second most frequent primary liver cancer, despite improvement of diagnosis only few patients can be submitted to resective surgery with curative intent. According to its location and characteristcs cholangiocarcinoma can be classified into two different categories: peripheral intrahepatic colangiocacinoma (ICC) and perihilar cholangiocarcinoma (PCC). The aim of this study is to compare the results of resective surgery of ICC and PCC. Methods. Ninety-five out of 152 patients observed between January 1990 and December 2007 in a single division of surgery of University of Verona Medical School underwent to surgical resection of a ICC (33 patients) or PCC (62 patients); the resectability rate was 62.5 %. R0 resection was achieved in 73 patients (77%). The surgical resections included 65 (66.%) major liver resections and 60 patients (62%) underwent combined extra-hepatic bile duct resection.Results. The median survival of the entire group was 24 months; actuarial 3- and 5-year survival was respectively 44% and 23%. Univariate analysis showed that the factors associated with survival were tumor type (ICC or PCC) , an R0 resection, lymph node metastasis and macroscopic vascular invasion. Multivariate analysis identified that R0 resection and macroscopic vascular invasion were the most important prognostic factors associated with survival, with hazard ratios of respectively 2.14 and 1.95. Further analysis identify that survival was significantly longer in ICC compared to PCC with a 5 years survival of 26 and 13 %, respectively. The analysis of the different clinico-pathological factors identified a significant higher rate of R+ resection, perineural infiltration, regional lymph node metastases and macro-vascular invasion in PCC compared to ICC.Conclusion. Our results confirm that only R0 resection can provide good long term survival. The macroscopic type of the tumor (ICC or PCC) is an important prognostic factor and the higher frequency of negative clinico-pathological factors can explain the worse prognosis of PCC.
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