Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand

Table 1 Characteristics of the 153 of patients with perihilar cholangiocarcinoma presented as number and percentage unless specified otherwise

Characteristics	n (%)
Gender
Male	113 (73.9)
Female	40 (26.1)
Mean ± SD of age (yr)	56.8 ± 8.22
Symptoms
Median (min-max) duration (d)	60 (3-300)
Abdominal discomfort	92 (60.1)
Jaundice	90 (58.8)
Weight loss	37 (24.2)
Fever	18 (11.8)
Co-morbidity	32 (20.9)
Hypertension	14 (9.1)
Diabetes mellitus	15 (9.8)
Renal failure	2 (1.3)
Chronic obstructive pulmonary disease	4 (2.6)
Hepatitis	3 (1.9)
Others	6 (3.9)

Table 2 Type and staging of perihilar cholangiocarcinoma

Characteristics	n (%)
Type
Bismuth I	5 (3.3)
Bismuth II	9 (5.9)
Bismuth IIIa	65 (42.5)
Bismuth IIIb	41 (26.8)
Bismuth IV	4 (2.6)
Right intrahepatic mass involving hilar	22 (14.4)
Left intrahepatic mass involving hilar	7 (4.6)
Staging
Stage 0	9 (5.9)
Stage I	9 (5.9)
Stage II	65 (42.5)
Stage IIIa	17 (11.1)
Stage IIIb	47 (30.7)
Stage IVa	4 (2.6)
Stage IVb	2 (1.3)

Table 3 Preoperative biliary drainage in jaundice patients (n = 90)

	Biliary drainage37 (41%)	Non-biliary drainage53 (59%)	P value
TB at presentation (mean ± SD)	19.4 ± 10.5	12.1 ± 15.8	0.06
TB at day before surgery (mean ± SD)	3.9 ± 4.1	17.1 ± 14.3	0.04
Post-operative complication	35%	37.70%	0.80
Length of hospital stay (mean ± SD)	15.6 ± 9.7	16.3 ± 7.6	0.56
Mortality (%)	0	2 (3.7)	-
Median survival time, mo (95%CI)	30.4 (16.3-58.7)	17 (12.2-26.6)	0.02
5-year survival rate, %(95%CI)	29.5 (14.1-46.7)	7.3 (0.9-22. 4)	0.02

TB: Serum total bilirubin.

Table 4 Operative procedure

Procedures	n (%)	Operative time; min(mean ± SD)	Blood loss;mL (mean ± SD)	Hospital stay;d (mean ± SD)	Morbidity	R0
Overall	153	326 ± 125	1274.2 ± 1312.5	15 ± 8.2	30%	43.1%
Right hepatectomy	63 (41.2)	334.3 ± 118.6	1480.2 ± 1644.9	15.4 ± 9	70.3%	31.7%
Right extended hepatectomy1	35 (22.9)	365.4 ± 133.7	1200.6 ± 881.5	15.6 ± 8.2	37.1%	51.4%
Left hepatectomy	47 (30.7)	319.4 ± 112	1180.5 ± 1082.9	15.2 ± 7.2	29.8%	53.2%
Extra hepatic duct resection	8 (5.2)	150.6 ± 55.4	481.2 ± 380.7	8.6 ± 5	0	37.5%
Portal vein resection	12 (7.8)	463.3 ± 101.1	1804.2 ± 1664.6	17.7 ± 8.7	50%	50%

¹Included right trisectionectomy.

Table 5 Bivariate analysis of clinico-pathological parameters

Variable	Number(person-months)	IRR/100	HR	95%CI	P value
Age (10 yr added)	153 (4026.8)	2.96	0.99	(0.97-1.01)	0. 743
Age (yr)					0.003
Less than 70	147 (3984.4)	2.84	1
70 or greater	6 (42.4)	14.15	4.71	(2.02-10.97)
Sex					0.066
Male	113 (2729.4)	3.33	1
Female	40 (1297.4)	2.16	0.68	(0.44-1.04)
Co-morbidity					0.281
Present	32 (1009.3)	2.48	0.79	(0.51-1.23)
Absent	121 (3017.5)	3.12	1
Operation					0.061
Right hepatectomy	63 (1389.1)	3.89	1
Right extended hepatectomy	35 (1059.3)	2.36	0.63	(0.39-1.03)
Left hepatectomy	47 (1412.6)	2.27	0.6	(0.39-0.93)
Bile duct resection	8 (165.8)	4.83	1.12	(0.53-2.36)
Portal vein resection					0.259
Yes	12 (3909.8)	2.92	1.49	(0.77-2.86)
No	141 (117.0)	4.27	1
Residual tumor status					< 0.001
R1	87 (2386.8)	4.63	1
R0	66 (1640.0)	1.8	0.40	(0.27-0.59)
Lymph node metastasis					< 0.001
N1, 2	103 (3248.6)	6.17	1
N0	50 (778.2)	2.19	0.38	(0.26-0.55)
Histology type
Papillary carcinoma	90 (2687.4)	2.38	1		0.012
Others	63 (1339.4)	4.11	1.61	(1.11-2.33)

IRR: Incidence rate per 100 person-months.

Table 6 Multivariable analysis of clinico-pathological parameters

Variable	IRR/100	UnadjustedHR	AdjustedHR1	95%CI	P value
Residual tumor status					< 0.001
R1	4.63	1	1
R0	1.8	0.40	0.42	(0.28-0.62)
Lymph node metastasis					< 0.001
N1, 2	6.17	1	1
N0	2.19	0.38	0.4	(0.27-0.59)
Histology type
Papillary carcinoma	2.38	1	1		0.018
Others	4.11	1.61	1.58	(1.08-2.30)

¹Each hazard ratio was adjusted for age and other factors listed in the table. IRR: Incidence rate per 100 person-months.

Table 7 Five-year survival after curative resection for perihilar cholangiocarcinoma in previous studies

Ref.	Place	Year	Resections	Morbidity	Mortality	R0	5-year survival rate
Present study	Thailand	2014	153	30%	2.00%	43.1%	20.6%
Nimura et al[21]	Japan	2000	100	49%	9.00%	61.0%	26.0%
Kondo et al[22]	Japan	2004	40	48%	0	95.0%	NA
Dinant et al[27]	Netherlands	2005	54	59%	11.00%	46.0%	38.00%
Jarnagin et al[28]	United States	2005	106	62.3%	7.50%	77.0%	NA
DeOliveira et al[29]	United States	2007	173	61%	5.00%	19.0%	10.00%
Ito et al[4]	United States	2008	38	32%	0	63.0%	33.00%
Paik et al[18]	Korea	2008	16	75%	0	81.2%	64.00%
Khuntikeo et al[23]	Thailand	2008	30	76.70%	6.70%	NA	0%
Hirano et al[24]	Japan	2010	146	44%	3.40%	87.0%	35.5%
Igami et al[25]	Japan	2010	298	43%	2.00%	74.0%	42.0%
Nagino et al[19]	Japan	2010	50	54%	2.00%	66.0%	30.3%
Cheng et al[10]	China	2012	176	26.3%	2.90%	78.4%	13.5%
Natsume et al[17]	Japan	2012	201	44.2%	1.00%	84.9%	35.2%
de Jong et al[6]	United States	2012	224	NA	6.70%	66.5%	20.2%
Nagino et al[7]	Japan	2013	574	57.30%	4.70%	76.5%	32.5%
Pattanathien et al[26]	Thailand	2013	58	NA	NA	46.6%	10.8%

NA: Not available.