Extended hepatectomy improve R resection rate and the prognosis of hilar cholangiocarcinoma: 68 patients single center analysis

Hilar Cholangiocarcinoma is a rare tumour accounting for less than 1% of all malignancies. This study was conceived to assess multimodal treatment including surgical approach and to determine postoperative morbidity, mortality rate and prognostic factors for long-term survival. From May 1992 to December 2006, 68 patients with a Klatskin tumour were evaluated at our institution. Clinicopathological data were analysed and univariate and multivariate analyses carried out to determine significant prognostic factors affecting morbidity and mortality. Mean age was of 53.4 ± 12 years. M/F ratio was of 46/22. After a median FU of 28 months (1-84), 11/68 (16%) of patients were non resectable (group A) and treated with palliative transtumoral stenting. The other 57 patients (group B) underwent surgery : n = 5 for Bismuth type II ; n = 20 for type IIIa ; n = 23 for type IIIb and n = 9 for type IV. Median survival was of 48 months in R vs. 10 months in R1-R2 resections (p = 0.003). Right or left extended hepatectomies accounted for more than 80% R resection. In-hospital mortality was of 3.5%. Overall morbidity rate was of 35%. Factors related to a shorter survival were identified as : lymphatic and perineural invasiveness, R1-R2 resection, AJCC stage and limited hepatectomy. Overall 3 & 5 years patient survival was of 45% and 22% respectively. Surgical aggressiveness with thorough lymphadenectomy and complete tumor removal increased R resections and, consequently, survival. Provided an acceptable surgical mortality as showed, radical oncological surgery was possible in more than 70% of cases.