Intra and extrahepatic cholangiocarcinomas - Clinical experience with 101 consecutive cases in a single institution

Objective: To evaluate the clinical characteristics and surgical results in patients with intra or extrahepatic cholangiocarcinoma. Patients and Methods: One hundred and one consecutive patients clinically diagnosed with intra or extrahepatic cholangiocarcinoma in a 15-year period were divided into four groups, i.e., intrahepatic, hilar, mid third and distal duct cholangiocarcinomas. The patients' clinical characteristics, expression of tumor markers, diagnostic tools and tumor stagings were reviewed. Operative complications and survival rates were analyzed and compared in each group. Results: Biliary tract stones were not uncommon in this study. Thirty-nine percent of the intrahepatic group had intrahepatic stones. The most common symptom in the intrahepatic type was abdominal pain while jaundice was most common in the hilar and distal types of cholangiocarcinomas. Three patients had choledocal cyst disease. Most patients (73%) were in stage III or stage IV. The resectability rate was 37% (37 patients) with a surgical mortality of 8.1% (3 patients). Wound infection and bile leak were the most common complications postoperatively. The overall 5-year actuarial survival rate was 6% and median survival 4 months. The 1-year, 3-year, 5-year survival rates of noncuratively resected patients were 11.11%, 7.60%, 1.75% for the ICCA (intrahepatic cholangiocarcinoma) group, 0%, 0%, 0% for the HCCA (hilar cholangiocarcinoma) group and 37.5%, 11.88%, 8.75% for the DCCA (distal duct cholangiocarcinoma) group. The curatively resected patients had significantly better survival than the non-curatively resected patients in each group, with 1year, 3-year and 5-year survival rates of 83.33%, 34.88% and 34.72% in the ICCA group, 14.44%, 9.63% and 4.81% in the HCCA group and 76.38%, 22.27% and 19.76% in the DCCA group. Conclusions: Survival after curative resection was significantly better than that after palliative procedures in the ICCA and DCCA groups. Aggressive surgery in resectable cases is suggested in the MCCA group, in order to improve survival.