BACKGROUND/AIMS: Hilar cholangiocarcinoma, still a
challenging problem for surgeons and resectional surgery,
is the treatment of choice for long-term survival. In this
study we tried to evaluate different prognostic factors after
resection. METHODOLOGY: From January 1995 to
October 2004, 440 patients with hilar cholangiocarcinoma
were admitted to the Gastroenterology Surgical Center,
Mansoura University, Egypt. Of these patients 73
underwent potentially curative resection giving
respectability rate of 17%, and the remaining 367 patients
underwent non-surgical treatment because of advanced
disease, advanced cirrhosis and poor general condition.
Of the 73 patients, 35 (48%) underwent localized hepatic
resection and 38 (52%) patients underwent major hepatic
resection. Various prognostic factors for survival were
evaluated by univariate and multivariate analysis.
RESULTS: Hospital mortality occurred in 8 (11%) patients.
The most common postoperative complications were: bile
leak, liver cell failure and wound infection 23.2%, 17.8%
and 9.5% respectively. The survival rates at 1, 2, 3, 4, and
5 years were 79%, 32.6, 18.5, 137% and 13%
respectively. The result of univariate analysis revealed
that radicality of resection, lymph nodes status, tumor
differentiation, modified Bismuth staging, underlying liver
pathology, HCV viral infection, blood transfusion,
preoperative serum bilirubin <10mg and CA19-9 are
dependent prognostic factors. By multivariate Cox
analysis radicality of resection, lymph nodes status, serum
bilirubin below 10mg/dL level of CA19-9 and hepatitis viral
infection were independent predictor factors.
CONCLUSIONS: From this study we found that
aggressive surgical procedure to obtain curative resection
with preoperative serum bilirubin below 10mg and HCV
infective negative especially in noncirrhotic liver may bring
a better prognosis in hilar cholangiocarcinoma.