OBJECTIVE: To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. SUMMARY BACKGROUND DATA: The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. METHODS: We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. RESULTS: Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively. CONCLUSION: R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.
OBJECTIVE: To assess long-term survival and prognostic factors in a large series of patients with bile duct cancer. SUMMARY BACKGROUND DATA: The incidence of bile duct cancer is low but increasing. Determinants of survival vary in the literature, due to a lack of sufficient numbers of patients in most series. METHODS: We studied 564 consecutive patients with bile duct cancer operated upon between 1973 and 2004. Patients were divided into intrahepatic, perihilar, and distal groups. Principle outcome measures were complications, 30-day mortality, and survival. RESULTS: Of the 564 patients, 44 (8%) had intrahepatic, 281 (50%) had perihilar, and 239 (42%) had distal tumors. Approximately half (294, 52%) were treated before 1995, while 270 (48%) were treated thereafter. The perioperative mortality rate was 4%. In log-rank analyses, survival was higher in the later time period (P = 0.002), in patients with intrahepatic disease (P = 0.001), with negative resection margins (P < 0.001), with well/moderately differentiated tumors (P < 0.001), and those with negative lymph nodal status (P < 0.001). In multivariate analysis, negative margins (P < 0.001), tumor differentiation (P < 0.001), and negative nodal status (P < 0.001), but not tumor diameter, were significant independent prognostic factors. In R0-resected patients, lymph node status (P < 0.001), but not tumor diameter, histology, or differentiation, further predicted survival. The median survivals for R0-resected intrahepatic, perihilar, and distal tumors were 80, 30, and 25 months, respectively, and the 5-year survivals were 63%, 30%, and 27%, respectively. CONCLUSION: R0 resection remains the best chance for long-term survival, and lymph node status is the most important prognostic factor following R0 resection.
Authors: M Miyazaki; H Ito; K Nakagawa; S Ambiru; H Shimizu; Y Shimizu; A Kato; S Nakamura; H Omoto; N Nakajima; F Kimura; T Suwa Journal: Surgery Date: 1998-02 Impact factor: 3.982
Authors: Sander Dinant; Michael F Gerhards; E A J Rauws; Olivier R C Busch; Dirk J Gouma; Thomas M van Gulik Journal: Ann Surg Oncol Date: 2006-04-14 Impact factor: 5.344
Authors: A Nakeeb; H A Pitt; T A Sohn; J Coleman; R A Abrams; S Piantadosi; R H Hruban; K D Lillemoe; C J Yeo; J L Cameron Journal: Ann Surg Date: 1996-10 Impact factor: 12.969
Authors: Parissa Tabrizian; Ghalib Jibara; Jaclyn F Hechtman; Bernardo Franssen; Daniel M Labow; Myron E Schwartz; Swan N Thung; Umut Sarpel Journal: HPB (Oxford) Date: 2014-11-14 Impact factor: 3.647
Authors: J R A Skipworth; S W M Olde Damink; C Imber; J Bridgewater; S P Pereira; M Malagó Journal: Aliment Pharmacol Ther Date: 2011-09-20 Impact factor: 8.171
Authors: Sarah B Fisher; Sameer H Patel; David A Kooby; Sharon Weber; Mark Bloomston; Clifford Cho; Ioannis Hatzaras; Carl Schmidt; Emily Winslow; Charles A Staley; Shishir K Maithel Journal: HPB (Oxford) Date: 2012-05-22 Impact factor: 3.647
Authors: Caitlin Hester; Ibrahim Nassour; Beverley Adams-Huet; Mathew Augustine; Michael A Choti; Rebecca M Minter; John C Mansour; Patricio M Polanco; Matthew R Porembka; Sam C Wang; Adam C Yopp Journal: J Gastrointest Surg Date: 2018-07-20 Impact factor: 3.452
Authors: Kaitlyn J Kelly; Katerina Dukleska; Deborah Kuk; T Peter Kingham; Michael I D'Angelica; Ronald P DeMatteo; Peter J Allen; William R Jarnagin; Yuman Fong Journal: Ann Surg Oncol Date: 2013-11-09 Impact factor: 5.344