Prognosis for patients with biliary malignancies has been poor, however, recent advances in radiology and laparoscopy have improved staging.
Active biliary stent management may also improve outcome.
|Patients resected between 1998 and 2001 had a median survival longer than 44 months.|
Currently, the surgical goal is to achieve negative microscopic margins even if a major hepatic resection is required.
In this study, researchers from the United States determined whether survival has improved with better staging, active stent management, more aggressive surgery, and with chemoradiation.
The research team assessed 140 patients with biliary malignancies, who were treated at the Medical College of Wisconsin, USA, between 1990 and 2001.
Of the malignancies, 111 were cholangiocarcinomas (intrahepatic 22%, perihilar 65%, and distal 13%), and 29 were gallbladder cancers.
During the study, 61% of patients underwent exploration (intrahepatic 58%, perihilar 57%, distal 67%, and gallbladder 72%), and 51% of these underwent resection (intrahepatic 64%, perihilar 41%, distal 70%, and gallbaldder 52%).
The team noted that chemoradiation with confocal radiation, 5-fluorouracil, and gemcitabine was used more frequently in the patients resected since 1998.
The research team found that 30-day operative mortality was 4%.
In the resected patients the 5-year actuarial survival was 31% and the median survival was 28 months.
However, they found that patients resected between 1998 and 2001 had a median survival longer than 44 months, with a 3-year actuarial survival of 70%.
This contrasted with patients resected between 1990 and 1997, who had a median survival of 13 months and a 3-year actuarial survival of 21%.
Dr Attila Nakeeb’s team concluded, “These data suggest that approximately one third of patients with biliary malignancies have resectable disease, and that surgery in carefully selected patients with adjuvant chemoradiation has improved survival in resected patients”.
“We suspect that a combination of improved staging, active biliary stenting, safe but extensive surgery to obtain negative margins, and newer techniques for chemoradiation have resulted in improved outcomes for patients with biliary malignancies”.