The researchers, from the University of Southern California, Los Angeles and the University of Rochester, Rochester, NY, critically evaluated the experience of a single center in the treatment of cholangiocarcinoma.
77 patients (38 male; median age, 71 years) with biopsy-confirmed adenocarcinoma of the extrahepatic bile ducts were enrolled in the retrospective study.
All of the subjects had been treated between January 1980 and February 1998, and were followed up for a median 48 months.
The main outcomes measured were prognostic variables, resectability rates, morbidity, and survival.
30% of patients underwent curative resections, 41% underwent palliative surgery, and 29% received nonoperative therapies.
The 30-day perioperative morbidity rate was found to be 18%, and mortality was 6%.
|Five-year survival rates after treatment:|
Nonoperative therapy: 0%
Palliative surgery: 10%
Curative resection: 55%
|Archives of Surgery|
Overall median survival was 11 months; 4 months for patients receiving nonoperative therapy; 8 months for patients recieving palliative surgery; and 72 months for curative resection. Five-year survival rates were 23%, 0%, 10%, and 55%, respectively.
The researchers found that curative resection was the only prognostic variable to have a statistically significant effect on survival.
Dennis Blom, of the Department of Surgery, University of Southern California, concluded, "Curative resection could be achieved in approximately one third of patients who had cholangiocarcinoma, and should be the goal of treatment.
"Survival is significantly improved in those patients who are considered to have resectable tumors and who undergo removal of all gross disease. Palliative surgical treatments also revealed a survival advantage over nonoperative therapies."