A Clinical Review for Peripheral Cholangiocarcinoma.
- Author:
Sang Seok CHOI
1
;
Chang Woo NAM
;
Young Joo LEE
;
Kwang Min PARK
;
Sung Gyu LEE
Author Information
1. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Peripheral cholangiocarcinoma;
Hepatic resection
- MeSH:
Abdominal Pain;
Adenocarcinoma;
Angiography;
Biomarkers, Tumor;
Bile Ducts, Intrahepatic;
Cholangiocarcinoma*;
Chungcheongnam-do;
Clonorchiasis;
Fever;
Hepatic Duct, Common;
Humans;
Jaundice;
Mastectomy, Segmental;
Neoplasm Metastasis;
Palliative Care;
Prognosis;
Retrospective Studies;
Survival Rate;
Ultrasonography;
Weight Loss
- From:Journal of the Korean Surgical Society
1998;55(1):110-119
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: A peripheral cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile ducts proximal to the second-order branch of the main hepatic duct, has a poor prognosis against various treatment modalities. We analyzed the clinical characteristics of peripheral cholangiocarcinomas and evaluated the outcomes of surgical treatment. METHODS: A retrospective study of 46 peripheral cholangiocarcinoma cases for which surgical exploration was performed at the Asan Medical Center over a 7-year period was conducted. RESULTS: Clinical manifestations on admission were abdominal pain including epigastric pain (89%), weight loss (33%), fever (28%), jaundice (24%), a palpable mass (20%), and general weakness (11%). Associated diseases were hepatolithiasis in 54.3% and clonorchiasis in 9%. Positive findings showing a hepatic mass were found in 75% of the cases by using computed tomography and in 52% of the cases by using ultrasonography. Angiographic hypervascularity was seen in 17.4% of the cases and hypovascularity in 82.6%. The gross morphologic types of the peripheral cholangiocarcinomas were mass-forming (74%), periductal infiltrative (17%), and intraductal growing (17%). Nodal metastasis was found in 48% of the patients. The location of the peripheral cholangiocarcinoma was the left lobe (54%), the right lobe (35%), the caudate lobe (4%) and both lobes (6%). Of the 46 patients, 29 underwent a hepatic resection from the lateral segmentectomy to the right trisegmentectomy, and 17 cases underwent palliative surgery. The 1-year and 2-year survival rates of the hepatic-resection cases were 62% and 50%, respectively. The 1-year and 2-year survival rates of the palliative-surgery cases were 32% and 21%, respectively univariate analysis showed that tumor size, growth pattern, nodal metastasis, the extent of the hepatic resection, and node dissection did not significantly affect the survival of the patients. CONCLUSIONS: Careful preoperative evaluation using computed tomography, ultrasonography, and angiography and a study of tumor markers for the possibility of a peripheral cholangiocarcinoma is necessary in risk groups with hepatolithiasis or clonorchiasis. Hepatic resection should be used in hepatolithiasis patients to improve the chance of survival.
