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SURGICAL OUTCOMES AND PROGNOSTIC FACTORS IN PATIENTS WITH HILAR CHOLANGIOCARCINOMA' RADICAL RESECTION AND PREOPERATIVE BILIRUBIN LEVEL WERE INDEPENDENT PROGNOSTIC FACTORS OF TUMOR RECURRENCE AND OVERALL SURVIVAL RATE
Xiangcheng Li*
The first affiliated hospital with nanjing medical university, Nanjing, China
Objectives
Hilar cholangiocarcinoma (CC) is the most common CC, accounting for about 50% of all CC. Complete surgical resection remains the only hope for long-term survival in patients with hilar CC. The objective of the current study was to evaluate the outcomes of patients with hilar CC who underwent surgical resection and then to analyze factors influencing curative resection, tumor recurrence and overall survival.
Methods
From May, 2006 to April, 2015, 113 patients with hilar CC underwent surgical resection were retrospectively analyzed based on clinic characteristics, operative details, tumor recurrence and long-term survival data.
Results
113 patients underwent curative resection and the rate of R0 resection was 70.8%. Combined liver resection was associated with significantly higher R0 rate than extrahepatic bile duct resection. Patients with Bismuth-Corlette type III and IV tumor had similar R0 resection rate with type I and II patients (70.0% and 73.9%, respectively). The overall 1-, 3-, and 5-year survival rates after resection were 76.1%, 37.2%, and 23% while the 1-, 3-, and 5-year tumor recurrence rates were 24.5%, 64.9%, 71.9%, respectively. Multivariate analysis showed that lymph node metastasis (P= 0.034), neural infiltration (P= 0.004), admission bilirubin level above 3.0 mg/dL (P= 0.043), positive resection margin (P=0.001) and late stage (T3 and T4, P< 0.001) were independent prognostic factors on overall survival. Furthermore, admission bilirubin level (p=0.007) and resection margin (p=0.017) were selected as significantly factors affecting early hilar CC recurrence within one year after resection. Our further analysis showed that high bilirubin level was related with more lymph node metastasis and lower R0 resection. Furthermore, admission of bilirubin level was associated with postoperative complication and recovery of liver function. However, the preoperative biliary drainage did not affect overall survival after resection for hilar CC patients.
Conclusion
R0 resection and admission bilirubin level were independent prognostic factors on overall survival and early tumor recurrence after surgical resection for hilar CC patients.
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