Surgical treatment of cholangiocarcinoma

To report the results of surgical treatment of intrahepatic cholangiocarcinoma with different procedures and to find the factors that may affect the long-term survival.

From 1987 to 1994, 57 patients with intrahepatic cholangiocarcinoma underwent laparotomy. Among them, resection was performed in 27 patients, operative drainage in 14 patients and biopsy only in 14 patients. The liver resections included 9 right lobectomies, 14 left lobectomies and 4 hilar resections. All specimens were stained with carcinoembryonic antigen (CEA) and HLA-DR monoclonal antibodies.

There were 7 postoperative mortalities, one in the resection group (1/27), two in the drainage group (2/14) and 4 in the biopsy group (4/14). Patients undergoing resection survived significantly longer (median, 8 months) (mean, 19 +/- 4 months) than patients undergoing drainage (median, 4 months) (mean, 6 +/- 2 months) and biopsy (median, 2 months) (mean, 3 +/- 1 months) (p < 0.01). After resection, univariate analysis showed that positive hiliar lymphnode was a poor prognostic sign and mucobilia was a good prognostic sign. Age, sex, size of tumors cell differentiation, clear margin, and positive HLA-DR and CEA had no effect on prognosis.

The results support the surgical resection of intrahepatic cholangiocarcinoma. Tumor free margin should be aggressively achieved but may not be necessary. Mucobilia is a good prognostic sign and positive hilar lymphnode is a grave sign.