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World J Gastroenterol. Nov 21, 2007; 13(43): 5754-5759
Published online Nov 21, 2007. doi: 10.3748/wjg.v13.i43.5754
Preoperative evaluation with T-staging system for hilar cholangiocarcinoma
Ru-Fu Chen, Zhi-Hua Li, Jia-Jia Zhou, Jie Wang, Ji-Sheng Chen, Qing Lin, Qi-Bing Tang, Ning-Fu Peng, Zhi-Peng Jiang, Quan-Bo Zhou
Ru-Fu Chen, Jia-Jia Zhou, Jie Wang, Ji-Sheng Chen, Qi-Bing Tang, Ning-Fu Peng, Qing Ling, Department of Hepatobiliary Surgery, the Affiliated Second Hospital, Sun Yat-sen University, 107 Yan-Jiang Xi Road, GuangZhou 510120, Guangdong Province, China
Zhi-Hua Li, Department of Oncology, the Affiliated Second Hospital, Sun Yat-sen University, 107 Yan-Jiang Xi Road, GuangZhou 510120, Guangdong Province, China
Zhi-Peng Jiang, Department of Emergency, the Affiliated Second Hospital, Sun Yat-sen University, 107 Yan-Jiang Xi Road, GuangZhou 510120, Guangdong Province, China
Author contributions: All authors contributed equally to the work.
Supported by Department of Radiology, The Second Affiliated Hospital, Sun Yat-sen University, Guangdong Province, China
Correspondence to: Quan-Bo Zhou, Department of Hepatobiliary Surgery, the Affiliated Second Hospital, Sun Yat-sen University, 107Yan-Jiang Xi Road, GuangZhou 510120, Guangdong Province, China. hnhszqb@yahoo.com.cn
Telephone: +86-13710782185 Fax: +86-20-81332430
Received: June 5, 2007
Revised: August 9, 2007
Accepted: October 21, 2007
Published online: November 21, 2007
Abstract

AIM: To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma.

METHODS: From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging.

RESULTS: The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage (P < 0.05). The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly (P < 0.001). Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection (28 mo vs 18 mo; P < 0.05). The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy (91.4% vs 68%; P < 0.05 ). And it was also higher in detecting port vein involvement (90% vs 54.5%; P < 0.05).

CONCLUSION: The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of long-term survival. MRCP/MRA coupled with color Doppler Ultrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.

Keywords: Hilar cholangiocarcinoma; Preoperative staging; Survival rate; Surgical treatment