[Intrahepatic bile duct carcinoma (cholangiocarcinoma)]

There is no high risk group for cholangiocarcinoma as there is for hepatocellular carcinoma, and it has a poor prognosis because many cases are diagnosed after it has become advanced. To date, there is no effective chemotherapy or radiation therapy for cholangiocarcinoma, and extended hepatectomy is the only effective treatment. In Japan, regional lymph node dissection and extended hepatectomy have been performed aiming at curative resection, but the 5-year survival in Japan is still low, only 26.1%. The Committee on the Japanese General Rules for the Clinical and Pathological Study of Primary Liver Cancer has divided macroscopic type into 3 patterns: mass-forming type, periductal infiltrating type, and intraductal growth type, to access prognosis on a common basis. According to these groups, our patients with the intraductal growth type had a good outcome, but patients with the mass-forming type and periductal infiltrating type had a poor outcome. Many papers have reported that the presence of lymph node metastasis makes the prognosis poor. Among our cases, the 5-year survival rate for all patients who underwent hepatectomy was 26.1% and the rate for patients positive for lymph node metastasis was 10.8%, as opposed to 45.1% for patients negative for lymph node metastasis. We examined the outcome according to histological type and found that based on the histological findings, the prognosis was increasingly poor in the following order: papillary adenocarcinoma, macrotubular carcinoma, microtubular carcinoma. To achieve curative treatment in the future it will be important to clearly define the extent of hepatectomy and determine the extent of lymph node dissection required, and clearly identify other prognostic factors.