Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors.

摘要: OBJECTIVE: The objective of this article is to introduce a simple method for classifying cholangiocarcinomas and apply system analyze large number patients from single institution. SUMMARY BACKGROUND DATA: For the past 2 decades, most western reports on cholangiocarcinoma have separated intrahepatic extrahepatic tumors subclassified latter group into proximal, middle, distal subgroups. However, "middle" lesions are uncommon managed often either with hilar resection or pancreatoduodenectomy. spectrum cholangiocarcinoma, therefore, best classified three broad groups: 1) intrahepatic, 2) perihilar, 3) tumors. These categories correlate anatomic distribution imply preferred treatment. METHODS: records all histologically confirmed who underwent surgical exploration at Johns Hopkins Hospital over 23-year period were reviewed. RESULTS: Of 294 18 (6%) had 196 (67%) 80 (27%) Age, gender, race, associated diseases similar among groups. Patients tumors, by definition, less likely (p < 0.01) be jaundiced more 0.05) present abdominal pain. resectability rate increased location (50% vs. 56% 91%), improved survival each site. Five-year rates resected 44%, 11%, 28%, median 26, 19, 22 months, respectively. Postoperative radiation therapy did not improve survival. In multivariate analysis 0.001. hazard ratio 2.80), negative microscopic margins 0.01, 1.79), preoperative serum albumin 0.04, 0.82), postoperative sepsis 0.001, hard 0.27) predictors outcome. CONCLUSIONS: Cholangiocarcinoma categories. Resection remains primary treatment, whereas adjuvant has no influence Therefore, new agents strategies deliver needed