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=0.033). Significant differences were noted between stages I and II (p=0.002), stages I and III (p=0.045), and stages I and IV (p<0.001) in BDC patients. Significant differences were also noted between stages I and IV (p=0.004), stages II and IV (p=0.011), and stages III and IV (p=0.029) in CCC patients.According to subgroup analyses, there were no significant differences in pathological grading (p=0.193 in wel, pap, p=0.193 in others), lymph node status (p=0.222 in patients with negative lymph node, p=0.315 in those with positive), resected portal vein invasion (p=0.513 in negative, p=0.062 in positive invasion). There was a significant difference according to the resectional status in pathology, longer survival was achieved in BDC not R0 (p=0.131) but R1, 2 resection (p=0.014). Also, there was significant difference according to T-factor, longer survival was achieved in BDC with not T1, 2 (p=0.915) but T3 and 4 tumor (p<0.001).On multivariate analysis, three independent factors were related to longer survival in BDC patients: achieved in curative resection with cancer free margin (R0) (p=0.024), well differentiated or papillary adenocarcinoma (p=0.011), and absence of lymph node metastasis (p<0.001). Five factors were related to longer survival in CCC patients: absence of intrahepatic daughter nodules (p<0.001), CEA level =<2.9 ng/mL (p=0.005), no red blood cell transfusion requirement (p=0.016), and absence or slight degree of lymphatic system invasion (p<0.001), and negative margin of the proximal bile duct (p=0.003).
Conclusions: BDC and CCC appear to have different prognosis after hepatobiliary resection. Therefore, differentiating between these two categories must impact on predicting postoperative survival in patients with perihilar cholangiocarcinoma.