Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution

Michelle L. DeOliveira, Steven C. Cunningham, John L. Cameron, Farin Kamangar, Jordan M. Winter, Keith D. Lillemoe, Michael A. Choti, Charles J. Yeo, Richard D. Schulick

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. SUMMARY BACKGROUND DATA: The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. METHODS: We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. RESULTS: Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively. CONCLUSION: R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.

Original languageEnglish (US)
Pages (from-to)755-762
Number of pages8
JournalAnnals of surgery
Volume245
Issue number5
DOIs
StatePublished - May 1 2007

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution'. Together they form a unique fingerprint.

  • Cite this

    DeOliveira, M. L., Cunningham, S. C., Cameron, J. L., Kamangar, F., Winter, J. M., Lillemoe, K. D., Choti, M. A., Yeo, C. J., & Schulick, R. D. (2007). Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution. Annals of surgery, 245(5), 755-762. https://doi.org/10.1097/01.sla.0000251366.62632.d3