Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2016; 8(6): 436-443
Published online Jun 27, 2016. doi: 10.4240/wjgs.v8.i6.436
Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma: A retrospective study of 5-year survivors
Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah
Mohamed Abd ElWahab, Ayman El Nakeeb, Ehab El Hanafy, Ahmad M Sultan, Ahmed Elghawalby, Waleed Askr, Mahmoud Ali, Mohamed Abd El Gawad, Tarek Salah, Gastroenterology Surgical Center, Mansoura University, Daqahlia 35516, Egypt
Author contributions: El Nakeeb A designed the research; Abd ElWahab M, El Nakeeb A, El Hanafy E, Sultan AM, Elghawalby A, Askr W, Ali M, Abd El Gawad M and Salah T performed the research; El Nakeeb A and Ali M analyzed the data; Abd ElWahab M, El Nakeeb A and Abd El Gawad M wrote the paper.
Institutional review board statement: This study was approved by the institutional review board of Mansoura University.
Informed consent statement: Informed consent was obtained from all patients to undergo surgery after a careful explanation of the nature of the disease and possible treatment with its complications.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ayman El Nakeeb, MD, Associate Professor of general surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Daqahlia 35516, Egypt. elnakeebayman@yahoo.com
Telephone: +20-10-6752021 Fax: +20-50-2243220
Received: January 30, 2016
Peer-review started: January 31, 2016
First decision: March 23, 2016
Revised: March 26, 2016
Accepted: April 14, 2016
Article in press: April 15, 2016
Published online: June 27, 2016
Abstract

AIM: To determine predictors of long term survival after resection of hilar cholangiocarcinoma (HC) by comparing patients surviving > 5 years with those who survived < 5 years.

METHODS: This is a retrospective study of patients with pathologically proven HC who underwent surgical resection at the Gastroenterology Surgical Center, Mansoura University, Egypt between January 2002 and April 2013. All data of the patients were collected from the medical records. Patients were divided into two groups according to their survival: Patients surviving less than 5 years and those who survived > 5 years.

RESULTS: There were 34 (14%) long term survivors (5 year survivors) among the 243 patients. Five-year survivors were younger at diagnosis than those surviving less than 5 years (mean age, 50.47 ± 4.45 vs 54.59 ± 4.98, P = 0.001). Gender, clinical presentation, preoperative drainage, preoperative serum bilirubin, albumin and serum glutamic-pyruvic transaminase were similar between the two groups. The level of CA 19-9 was significantly higher in patients surviving < 5 years (395.71 ± 31.43 vs 254.06 ± 42.19, P = 0.0001). Univariate analysis demonstrated nine variables to be significantly associated with survival > 5 year, including young age (P = 0.001), serum CA19-9 (P = 0.0001), non-cirrhotic liver (P = 0.02), major hepatic resection (P = 0.001), caudate lobe resection (P = 0.006), well differentiated tumour (P = 0.03), lymph node status (0.008), R0 resection margin (P = 0.0001) and early postoperative liver cell failure (P = 0.02).

CONCLUSION: Liver status, resection of caudate lobe, lymph node status, R0 resection and CA19-9 were demonstrated to be independent risk factors for long term survival.

Keywords: Hilar cholangiocarcinoma, Hepatic resection, Caudate lobe resection, CA19-9, Liver cell failure

Core tip: Hilar cholangiocarcinoma is an uncommon malignancy with a relatively poor prognosis. Surgery remains the only line of treatment offering the possibility of cure. The central location of the tumor and its close relationship to vascular structures at the hepatic hilum have resulted in a low resectability rate. Five year survivors were younger at diagnosis than those surviving less than 5 years. Major hepatic resection and caudate lobe resection achieved better R0 resection rate. Liver status, resection of caudate lobe, lymph node status, R0 resection and CA19-9 were demonstrated to be independent risk factors for long term survival.