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[Proximal bile duct cholangiocarcinomas]
M C Blanchet1, C Ducerf, L Benoit
1Service de chirurgie digestive et de la transplantation hépatique, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon, France.
Aim:
The aim of this retrospective study was to report a series of 12 patients with hilar cholangiocarcinoma treated by curative resection.
Patients And Methods:
Between 1980 and 1998, curative resection was performed in 12 patients out of 33 patients with a Klatskin's tumor. Preoperative biliary drainage was performed in 6 cases. Resection was limited to the extrahepatic bile duct in one case only. Resection was extended to the liver in 11 cases including segmentectomy I (n = 9), left hepatectomy (n = 7), right hepatectomy (n = 3) and segmentectomy IV (n = 1). Postoperative brachytherapy was performed in 3 patients combined with conventional radiotherapy. Conventional radiotherapy irradiation was performed in 2 patients and was associated with chemotherapy in 1 patient.
Results:
There was no postoperative mortality. Postoperative follow-up was uneventful in 5 patients. Actuarial survival rate at 1, 2, 3, and 5 years was 81, 57, 28 and 28%, respectively. Prolonged survivals (88 and 114 months) were observed.
Conclusion:
Hilar cholangiocarcinomas have a poor prognosis. Curative resections are usually performed with major liver resections. RM cholangiography is now the most efficient examination for selection of surgical indications and choice of the best strategy. Long-term survival can be obtained with curative surgery. Adjuvant treatment has to be assessed by controlled trials.