Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

Abstract

Background Hilar cholangiocarcinoma (HCCA) is a challenging problem for surgeons because surgery is the only effective therapy for these patients. In this study, we review 15 years of HCCC cases and treatment at a single Egyptian center. Methods From January 1995 to October 2010, 825 patients with HCCC were referred to Gastroenterology Surgical Center, Mansoura University, Egypt. From those 243 underwent potentially curative resection giving respectability rate of 29.4%, and the remaining patients (70.6%) underwent non-surgical treatment because of advanced disease, advanced cirrhosis, poor general condition and distant metastasis and locally advanced diseases. Data were recorded for the 243 cases (subjected to different types of hepatic resection), including demographics, medical history, presenting symptoms, and biochemical, radiological, and pathological parameters. ResultsThe overall resectability rate of the patients studied was 29.4% (243/825). Localized resection, right hepatectomy, or left hepatectomy were completed in 30.5%, 22.6%, and 46.9% respectively, and segment one in 58 % R0 status was achieved in 49.8% of patients. The overall complication rate was 35%. Operative mortality was 6.6% with a five-year survival rate of 16%. Recurrence occurred in 92 (37.8%) the site of recurrence was hepatic (24.3%) and local (13.5%). Resection margin (R0) (P<0.001), lymph node status (P<0.001) (negative), degree of differentiation (P<0.001), segment one resection (P<0.001) (positive), and status of liver (P<0.001) (normal or cirrhotic) predicted statistically higher survival (P<0.001). According to multivariate analysis, R0 lymph node status and well differentiated status. Prediction improved survival among all patients. Conclusion From these case studies, aggressive surgery with caudate lobe resection with normal liver parenchyma may produce better prognoses in patients with resectable HCCA.

Primary hepatic neuroendocrine tumor associated with hypertension: A case report

“…Surgical resection was mostly effective and used by hepatectomy and lymphadenectomy (8). For patients with metastatic liver, interventional therapy by arterial embolization, chemoembolization, or radioembolization was adopted to reduce lesions; an alternative therapy could be local ablative by RFA, cryotherapy, and microwave, so as to strive for the opportunity of surgery, but its benefit is debatable (5,9,10). Also, liver transplantation in the treatment of PHNETs acquired a certain therapeutic effect from the study of Alekseev et al (11).…”

Postoperative Outcome after Major Liver Resection in Jaundiced Patients with Proximal Bile Duct Cancer without Preoperative Biliary Drainage

“…As aggressive surgery with caudate lobe resection may produce better prognoses in patients with resectable hilar cholangiocarcinoma [41], we, like other authors, do not recommend the routine use of PBD in patients with proximal bile duct cancer [15,42,43,44] but recommend PBD in selected patients such as those with a severely malnourished status or hypoalbuminemic patients or patients suffering from acute cholangitis or long-standing jaundice. Also major hepatectomy with removal of more than 50% of liver parenchyma in undrained patients is associated with high morbidity and mortality.…”